EUS-guided gastroenterostomy by use of a lumen-apposing metal?stent to facilitate ERCP in a patient with duodenal switch anatomy

摘要

Lumen-apposing metal stents (LAMSs) have gained popularity in a variety of clinical scenarios. Whereas LAMSs were initially used to drain pancreatic fluid collec- tions, several off-label uses have been developed, including EUS-guided access to facilitate ERCP in patients with surgically altered anatomy. The duodenal switch procedure is a bariatric surgical procedure that induces weight loss by combining a sleeve gastrectomy with an intestinal bypass. This procedure renders the ampulla nearly inaccessible to conventional endoscopic access. Alternative options are challenging at best, because sur- gically assisted ERCP requires small-bowel access for endoscopic entry and balloon-assisted enteroscopy is limited by the long length of the pancreaticobiliary limb and the need for retrograde access, given that the enteroenterostomy is often close to the ileocecal valve. We describe the use of a LAMS to obtain biliary access and facilitate ERCP in a patient with duodenal switch anatomy.