A novel collaborative approach to endoscopic double bypass in concomitant gastric outlet and biliary obstruction

摘要

Attention was then shifted to the hepatogastrostomy. Under EUS guidance, a dilated hepatic segment III left intrahepatic bile duct was visualized. A transgastric puncture of the duct was performed with a 19-gauge needle, followed by the advancement of a 0.035-inch guidewire into the common bile duct ([Fig. 2 a]). The hepatogastrostomy track was then dilated using a 4-mm dilating balloon, followed by successful deployment of a 10 × 80 mm partially covered, self-expandable metal stent ([Fig. 2 b], [Fig. 3]). Fig. 2 Fluoroscopic view. a Transgastric guidewire coiled in the hepatic hilum. b The fully deployed 80-mm, partially covered, self-expandable metal stent forming hepatogastrostomy. Fig. 3 Post-procedural abdominal radiograph, showing all stents in place. A full, low-residue diet was initiated 48 hours post-procedure, with excellent tolerance. The PTBD was removed 3 days later. Bilirubin levels had decreased by more than 50 % at the 1-week follow-up. We describe the first reported EUS-guided double bypass performed in collaboration with interventional radiology. Combining endoscopic and interventional radiology techniques may enhance the safety and ease of this novel approach. However, further studies will be needed to validate this new approach. Endoscopy_UCTN_Code_TTT_1AO_2AIEndoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.