Endoscopy 2019; 51(04): S99
DOI: 10.1055/s-0039-1681461
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 08:30 – 10:30: Video ERCP 1 South Hall 1A
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC RENDEZVOUS FOR AN ANASTOMOTIC STRICTURE AFTER HEPATOJEJUNOSTOMY

C Gerges
1   Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
,
P Weber
1   Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
,
PD Siersema
2   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
,
H Neuhaus
1   Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
,
EJM van Geenen
2   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
,
T Beyna
1   Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available ateRef
 

Aims:

Anastomotic stenosis of the hepatojejunostomy (HJS) remain a common complication and a major cause of morbidity. (Balloon assisted)-ERCP is the golden standard to treat HJS. In 38% BE-ERCP is not successful because of the inability to reach and/or cannulate the anastomosis. An alternative is surgical treatment, which is associated with significant morbidity and mortality. Surgery can be contraindicated by ASA3 plus patients. For those patients long term trans hepatic biliary drainage might be a therapeutic option. In this case we show a trans hepatic, cholangioscopy guided reopening of a bilioenteric anastomosis stricture.

Methods:

We report the case of a 71-year-old female with adenocarcinoma of the papilla, who received a pylorus-sparing pancreaticoduodenectomy and developed a HJS with recurrent cholangitis. Former two surgical revisions and ERCPs failed.

At our center ERCPs with small, long colonoscope and duodenoscope were performed. The HJS were identified at the expected place of the neo-papilla, but biliary cannulation was impossible. In order to obtain biliary drainage a PTCD-Series with a dilation of the bile duct was performed. A cholangioscope was inserted through the PTCD up to the hepatojejunostomy, which showed a complete stricture of the anastomosis. In a rendezvous maneuver diaphany was achieved with the colonoscope while the stricture could be re-opened with a needle knife under cholangioscopic control.

Results:

After a large incision the cholangioscope was able to pass into the small bowel. A transhepatic drainage catheter was placed through the opened HJS. Three months later the re-opened HJS was stabilized and the catheter could be extracted, with a passage of bile through the treated HJS.

Conclusions:

In certain cases, cholangioscopic incision of the bilioenteric anastomosis in a rendezvous maneuver can be an alternative to long term PTCD. For the safely success of the procedure diaphany established with a second endoscope was found to be essential.