Endoscopy 2019; 51(04): S155
DOI: 10.1055/s-0039-1681626
ESGE Days 2019 ePoster podium presentations
Friday, April 5, 2019 14:00 – 14:30: ERCP stenosis ePoster Podium 4
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC PALLIATION OF HILAR COLANGIOCARCINOMA – USEFULNESS OF SELECTIVE OCCLUSION OF ONE INTRAHEPATIC DUCT

J Fernandes
1   Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
2   Gastroenterology, Centro Hospitalar Cova da Beira, Covilhã, Portugal
,
M Moreira
1   Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
,
T Araújo
1   Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
,
H Ribeiro
1   Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
,
S Giestas
1   Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
,
F Lucas
3   Serviço de Medicina do Hospital de Cascais, Cascais, Portugal
,
D Libânio
1   Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
4   Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
,
J Ramada
1   Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
,
D Martinez-Ares
1   Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
,
M Certo
5   Hospital de Braga, Braga, Portugal
,
J Canena
6   Gastroenterology, Hospital Amadora Sinta, Amadora, Portugal
7   Gastroenterology, Nova Medical School/FCML da UNL, Lisbon, Portugal
,
L Lopes
1   Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
8   Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
9   ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Description:

ERCP with stent placement for palliative biliary drainage is a common strategy used in the management of patients with unresectable hilar cholangiocarcinomas (HC).

Selective placement of two guidewires, one in the right intrahepatic duct (RIHD) and the other in the left hepatic duct (LIHD) is an essential pre-requisite for bilateral stenting. However, the insertion of the second guidewire to the contralateral intrahepatic duct can be extremely difficult in some patients, even after using multiple maneuvers, using different types of catheters and guidewires.

In this video, we demonstrate a technique to overcome the inability to direct the second guidewire to the contralateral intrahepatic duct. We describe an 85-year old man, with a type II HC, referred to our department for palliative bilateral stenting. After swiftly passing the first guidewire to the right lobe, we faced unexpected difficulties in directing the second guidewire to the dilated LIHD. Several maneuvers were attempted, including the use of angled-tip and small caliber hydrophilic wires, but all resulted invariably in cannulation of the right system. In order to overcome this difficulty, we introduced a 15-mm retrieval balloon into the dilated RHD; the balloon was inflated immediately proximal to the hepatic bifurcation, blocking the access to the RIHD. Subsequently, a second guidewire was inserted alongside the balloon catheter, across the hilar stricture and easily deflected off the inflated balloon into the LIHD. Two self-expandable metal stents were successfully deployed.

Motivation:

To the best of our knowledge there are no multimedia reports on this technical tip to facilitate the passage of a second guidewire to the opposite intrahepatic duct, which was first reported by Husain et al. Use of this technical maneuver could be a very useful tool for increasing the success of bilateral stenting in patients with hilar cholangiocarcinoma.