Salvage technique for endoscopic stent removal using a thin-tipped balloon catheter during endoscopic ultrasound-guided hepaticoduodenostomy.
Salvage technique for endoscopic stent removal using a thin-tipped balloon catheter during endoscopic ultrasound-guided hepaticoduodenostomy.
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内镜超声引导肝十二指肠吻合术中使用细尖球囊导管进行内镜支架取出的抢救技术。
DOI：
10.1055/a-1694-3617
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发表时间：
2021
期刊：
影响因子：
9.3
通讯作者：
Shin Maeda
中科院分区：
文献类型：
--
作者：
Tomohiro Ishii;Takashi Kaneko;Yuichi Suzuki;Masaki Nishimura;Kazuya Sugimori;Ichiro Kawana;Shin Maeda
内镜逆行胰胆管造影术（ERCP）失败后，有时进行内镜超声引导下肝十二指肠吻合术（EUS-HDS）进行右肝内胆管引流[1]。在EUS-HDS期间，我们在取出塑料支架时遇到困难。我们描述了一种在EUS-HDS期间使用细头球囊导管进行内镜支架取出的补救技术。一名34岁女性因反复胆管炎入院治疗。她在儿童时期接受了先天性胆管扩张手术，并进行了肝管空肠吻合术的Roux-en-Y重建。手术后，因右肝内胆管吻合口狭窄，出现慢性反复胆管炎（[图1]、[图2]）。使用单气囊肠镜的ERCP失败。对右肝内胆管进行了EUS-HDS。由于反复胆管炎，胆管僵硬;因此，我们使用6 Fr导丝烧灼扩张器进行扩张。我们尝试插入7-Fr塑料支架（通过和通过; Gadelius Medical，Co.，有限公司、东京，日本），但由于扩张不足，无法通过胆管壁。我们试图取出支架，但失败了;支架的远端瓣钩在十二指肠外壁上。在EUS-HDS过程中，在保持导丝的同时取出塑料支架的方法很少。我们选择使用球囊导管。将支架的内鞘拉出，并将细头球囊导管（4 mm直径REN; Kaneka Medical，Osaka，Japan）插入内镜通道内的支架中。我们充盈了支架内的球囊并成功将其拔出（[视频1]，[图3]）[2][3]。此后，我们再次扩张瘘管，并成功插入7 Fr塑料支架，无并发症。
Endoscopic ultrasound-guided hepaticoduodenostomy (EUS-HDS) is sometimes performed for right intrahepatic duct drainage after failure of endoscopic retrograde cholangiopancreatography (ERCP)[1]. We experienced difficulty in removing a plastic stent, during EUS-HDS. Here, we describe a salvage technique for endoscopic stent removal using a thin-tipped balloon catheter during EUS-HDS.A 34-year-old woman was admitted to our hospital for treatment of repeated cholangitis. She underwent surgery for congenital biliary dilatation in childhood, and Roux-en-Y reconstruction with hepaticojejunostomy was performed. After surgery, she suffered from chronic repeated cholangitis because of anastomotic stenosis of the right intrahepatic duct ([Fig. 1],[Fig. 2]). ERCP using a single-balloon enteroscope failed. EUS-HDS was performed for the right intrahepatic duct. The bile duct was stiff because of repeated cholangitis; therefore, we used a 6-Fr wire-guided cautery dilator for dilation. We attempted to insert a 7-Fr plastic stent (Through and Pass; Gadelius Medical, Co., Ltd., Tokyo, Japan) but could not pass it through the bile duct wall due to insufficient dilation. We tried to remove the stent, but failed; the distal flap of the stent was hooked to the outer duodenal wall. Few methods for plastic stent removal during EUS-HDS while maintaining the guidewire have been reported. We elected to use a balloon catheter. The inner sheath of the stent was pulled out and a thin-tipped balloon catheter (4-mm-diameter REN; Kaneka Medical, Osaka, Japan) was inserted into the stent inside the scope channel. We inflated the balloon inside the stent and succeeded in pulling it out ([Video 1],[Fig. 3])[2][3]. Thereafter, we dilated the fistula again and succeeded in inserting a 7-Fr plastic stent without complications.
扩展适应症：超声内镜引导下肝十二指肠吻合术治疗孤立性右肝内导管阻塞（附视频）。
影响因子：
7.7
作者：
Se Jeong Park;Jun;D. Park;Joon Hyuk Choi;S. Lee;D. Seo;S. Lee;Myung
通讯作者：
Myung
DOI：
10.12659/ajcr.896076
发表时间：
2016-02-05
期刊：
The American journal of case reports
影响因子：
--
作者：
Calcara C;Broglia L;Comi G;Balzarini M
通讯作者：
Balzarini M
在直接经口胆管镜检查的辅助下，使用支架内球囊充气技术成功内窥镜取出嵌入式胆道支架
影响因子：
5.3
作者：
N. Fujimori;S. Yasumori;T. Oono
通讯作者：
T. Oono