Rendezvous Ercp Via EUS-Guided Gallbladder Drainage To Salvage Lumen-Apposing Metal Stent (LAMS) Dislodgement During EUS-Guided Choledochoduodenostomy

Biliary (distal) flange dislodgment occurred during EUS-choledochoduodenostomy with LAMS for unresectable pancreatic malignancy. Guidewire dislodgment precluded a bridging stent. Aerobilia hampered repeat EUS-guided puncture. The gallbladder was used as a surrogate target for biliary drainage. A 15-mm cholecystogastric LAMS was placed under EUS-guidance. To minimize choledochal leakage, rendezvous ERCP was also undertaken. Through-the-LAMS cholecystoscopy with a gastroscope allowed antegrade transcystic guidewire passage into the duodenum. Parallel cannulation with a slit sphincterotome allowed fully-covered biliary metal stent placement across the stricture, overlapping the choledochal perforation. The dislodged biliary LAMS was removed, closing with hemoclips the duodenal perforation. The patient recovered uneventfully.

Citation: Sanchez-Ocaña R, de Benito Sanz M, Najera Muñoz R et al. OP59V RENDEZVOUS ERCP VIA EUS-GUIDED GALLBLADDER DRAINAGE TO SALVAGE LUMEN-APPOSING METAL STENT (LAMS) DISLODGEMENT DURING EUS-GUIDED CHOLEDOCHODUODENOSTOMY. Endoscopy 2021; 53: S25.

Publication History

Article published online:
19 March 2021