EUS-GUIDED GASTRO-BULBOSTOMY (EUS-GBS) WITH LUMEN-APPOSING METAL STENT (LAMS) AS A ROUTE FOR ERCP IN UPSIDE-DOWN STOMACH (UDS)

Background Gastric herniation into the posterior mediastinum precludes ERCP in UDS.

Case A duodenoscope loops into an UDS preventing pyloric passage. A dilated CBD is imaged with a linear echoendoscope. EUS-guided transgastric cholangiography confirms choledocholithiasis. An 8.5F nasobiliary tube is placed through the pylorus into the duodenum. Contrast, saline and methylene-blue injection through the tube outline and distend the bulb next to the stomach. A 20x10mm cautery-enabled LAMS is placed for gastro-bulbostomy and balloon-dilated. A duodenoscope is passed through the LAMS for sphincterotomy and stone removal.

Comments EUS-GBS allowed single-session ERCP in UDS, overcoming an uncommon reason for ERCP failure.

Publication History

Article published online:
14 April 2022