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Coil valve syndrome: a rare complication of percutaneous transhepatic obliteration successfully treated by argon plasma coagulation and double-balloon endoscopy
12 April 2019 (online)
Percutaneous transhepatic obliteration (PTO) is now widely used for prophylactic treatment of gastric varices . A straying coil tip in the stomach is sometimes reported as an adverse event  , but there have been no reports of one reaching the small intestine from the stomach.
In this case, the migrated coil tip with food residue was shaped like a ball and passed into the jejunum, causing a phenomenon resembling ball valve syndrome .
A 70-year-old woman was admitted with epigastric pain. She had been treated for gastric varices by PTO with coils ([Fig. 1]) 4 years earlier. One of these had migrated into the stomach asymptomatically 1 year after PTO ([Fig. 2]) and had been carefully monitored. Esophagogastroduodenoscopy on admission revealed the coil extending through the stomach and hooking into the mucosa at the angular portion of the stomach ([Fig. 3]). Abdominal computed tomography revealed that the coil tip was now in the jejunum ([Fig. 4]). Because of the risks of ulceration, perforation, or intussusception, we decided to remove it. Oral double-balloon enteroscopy (DBE) detected the coil tip enveloped by food residue in the jejunum; we carefully grasped it using forceps and pulled it back into the stomach. At first, we failed to cut the coil wire using a scissor-type electrical knife and loop cutter, but we finally succeeded in cutting it using argon plasma coagulation (APC) ([Video 1]). There were no adverse events during this procedure and the patient’s symptoms improved.
Video 1 “Coil valve syndrome”: a rare complication of percutaneous transhepatic obliteration for gastric varices that was successfully treated by argon plasma coagulation (APC) and double-balloon endoscopy (DBE).
The recovered coil was an 82-cm cerecyte coil. It was only possible to cut it using APC because the coil wire had unraveled and lengthened ([Fig. 5]). Compared with radiologists, few gastroenterologists know about migrated PTO coils and their characteristics.
This case shows a rare complication of PTO that was successfully treated by APC and DBE. We propose to describe this “coil valve syndrome” as “ball valve-like syndrome due to deviated coil.”
Koji Nagaike, Shiro Hayashi, Kengo Nagai et al. Coil valve syndrome: a rare complication of percutaneous transhepatic obliteration successfully treated by argon plasma coagulation and double-balloon endoscopy. Endoscopy 2019, doi:10.1055/a-0881-2667
In the above-mentioned article, the name of the author Yuichi Yoshida has been corrected. This was corrected in the online version on May 27, 2019.
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