ACUTE IATROGENIC GASTRIC PERFORATION DURING EUS FOR DISTAL MALIGNANT BILIARY OBSTRUCTION: SAME-SESSION INTRA-OPERATIVE OVER-THE-SCOPE-CLIP CLOSURE, DUODENAL STENTING AND EUS-GUIDED DRAINAGE WITH LUMEN APPOSING METAL STENT

A 72-year-old woman with pancreatic head's mass and dilated bile ducts was scheduled for tissue acquisition and biliary drainage. EUS was performed with linear echoendoscope (GF-UCT140; Olympus) with CO2 insufflation. During the advancing maneuvers of the echoendoscope to reach the duodenum, we detected a full-thickness 14-mm defect of gastric angulus with direct access into the peritoneum. An over-the-scope clip (OTSC 14/6t, Ovesco-Germany) was immediately deployed closing the iatrogenic perforation and allowing to complete the procedure with EUS-FNB of the lesion, duodenal uncovered self-expandable metal stent placement for neoplastic infiltration of duodenal bulb and EUS-guided choledoco-duodenostomy with 10 × 20-mm Hot-Spaxus (Taewoong).

Publication History

Article published online:
14 April 2022