Endoscopic ultrasound—assisted rendezvous technique followed by dual-duct drainage using a double-lumen papillotome: a salvage strategy for postendoscopic papillectomy stricture

Q3 Medicine

VideoGIE Pub Date : 2026-08-01 Epub Date: 2026-03-06 DOI:10.1016/j.vgie.2026.02.013

Go Endo MD, Naminatsu Takahara MD, PhD, Hiroto Nishio MD, Kensaku Noguchi MD, PhD, Tatsuya Sato MD, PhD, Ryunosuke Hakuta MD, PhD, Yousuke Nakai MD, PhD, Mitsuhiro Fujishiro MD, PhD

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引用次数: 0

Abstract

Background and Aims

Papillary stricture is a clinically relevant late adverse event of endoscopic papillectomy (EP) and may result in concurrent cholangitis and pancreatitis. Although endoscopic drainage is the first-line modality, biliary and pancreatic duct access can be challenging because of fibrotic strictures after EP. This article aims to demonstrate the feasibility of EUS-assisted rendezvous (EUS-RV) combined with a double-lumen papillotome (MagicTome; PIOLAX Inc, Yokohama, Japan) to achieve dual-duct access.

Methods

We present a case of a 70-year-old woman with cholangitis and pancreatitis caused by post-EP stricture. After a failed ERCP, a salvage EUS-RV was performed to access the biliary duct, followed by pancreatic duct cannulation using a double-lumen papillotome.

Results

The distal bile duct was punctured from the duodenum with a 19-gauge needle (EZ Shot 3 Plus; Olympus, Tokyo, Japan), and a 0.025-inch guidewire (VisiGlide 2; Olympus) was advanced through the stricture into the duodenum. The guidewire was retrieved with biopsy forceps, and biliary access was established. Subsequently, using a double-lumen papillotome, we cannulated the pancreatic duct. Balloon dilation and plastic stent placement were performed in both ducts without adverse events. The stents were removed after 12 months. No recurrence was observed during 12 months of follow-up.

Conclusions

EUS-RV combined with a double-lumen papillotome is a useful salvage strategy for complete post-EP strictures. This method can be applied to difficult cannulation, particularly when dual-duct access is required.

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内窥镜超声辅助交会技术后采用双腔乳头清扫器双管引流：一种内窥镜乳头切除术后狭窄的抢救策略

背景和目的乳头狭窄是内镜乳头切除术（EP）的临床相关晚期不良事件，可能导致并发胆管炎和胰腺炎。虽然内窥镜引流是一线方式，但由于EP后的纤维化狭窄，胆管和胰管通路可能具有挑战性。本文旨在证明eus辅助交会（EUS-RV）与双腔乳头清扫器（MagicTome; PIOLAX Inc ., Yokohama, Japan）结合实现双导管通路的可行性。方法我们报告一位70岁的女性患者，她患有ep后狭窄引起的胆管炎和胰腺炎。ERCP失败后，行补救性EUS-RV进入胆管，随后使用双腔乳头状腔胰管插管。结果19号针（EZ Shot 3 Plus; Olympus, Tokyo, Japan）从十二指肠穿刺远端胆管，0.025英寸导丝（VisiGlide 2; Olympus）穿过狭窄进入十二指肠。用活检钳取出导丝，建立胆道通路。随后，我们使用双腔乳头状腔对胰管进行插管。球囊扩张和塑料支架置入术均无不良反应。12个月后取出支架。随访12个月无复发。结论eus - rv联合双腔乳头化器是治疗完全性心绞痛后狭窄的有效方法。这种方法可以应用于困难的插管，特别是当需要双导管接入时。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.