Advanced endoscopic rescue after failed endoscopic ultrasound–guided choledochoduodenostomy

Q3 Medicine

VideoGIE Pub Date : 2026-08-01 Epub Date: 2026-03-12 DOI:10.1016/j.vgie.2026.02.015

Stefan Michaelis MD, Ulrich Rosien MD, Alexander Arlt MD, PhD

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引用次数: 0

Abstract

Background and Aims

EUS-guided choledochoduodenostomy (EUS-CDS) has become an established alternative to percutaneous or surgical approaches in cases of failed or predicted difficult ERCP.

Methods

We report a case of complex endoscopic management of biliary obstruction in a 46-year-old woman with inoperable pancreatic adenocarcinoma. Because of tumor-related deformation of the papillary region, primary transpapillary drainage was not feasible.

Results

EUS-CDS using a 6- × 8-mm electrocautery-enhanced lumen-apposing metal stent (LAMS) (Hot AXIOS stent; Boston Scientific, Marlborough, Mass, USA) was performed. Misdeployment of the distal flange led to bile leakage and stent dysfunction. Subsequent placement of a fully covered self-expandable metal stent (8 mm × 6 cm) (BONASTENT; MTW, Wesel, Germany) resulted in secondary stent dislocation into the paraduodenal space. The dislocated stent was successfully retrieved endoscopically through the original access using a 3-mm cholangioscope (Scivita, Boston Scientific). The duodenal defect was closed with 2 closure clips (MANTIS Clip, Boston Scientific). The patient recovered uneventfully and remained asymptomatic at 2-month follow-up.

Conclusions

This case illustrates the feasibility of endoscopic rescue in a challenging scenario after LAMS misdeployment using advanced ERCP and closure techniques.

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超声内镜引导胆总管十二指肠吻合术失败后的先进内镜抢救

背景和aimseus引导下的胆总管十二指肠吻合术（EUS-CDS）已成为经皮或手术入路的替代方案，用于失败或预测困难的ERCP。方法我们报告一例复杂的内镜下胆道梗阻的管理在46岁的妇女不能手术胰腺癌。由于肿瘤相关的乳头区变形，原发性经乳头引流是不可行的。结果us - cds采用6 × 8 mm电灼增强腔旁置金属支架（lam）（Hot AXIOS支架；Boston Scientific, Marlborough, Mass， USA）。远端法兰的错误部署导致胆汁泄漏和支架功能障碍。随后放置全覆盖自膨胀金属支架（8 mm × 6 cm）（BONASTENT； MTW, Wesel, Germany）导致支架继发性脱位进入椎间间隙。使用3毫米胆道镜（Scivita, Boston Scientific）通过原始通道成功地在内窥镜下取出脱位的支架。用2个闭合夹（MANTIS Clip, Boston Scientific）闭合十二指肠缺损。患者恢复平稳，随访2个月无症状。结论：本病例说明了采用先进的ERCP和闭合技术在LAMS误部署后的具有挑战性的情况下进行内窥镜救援的可行性。

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.