Management of Sphincter of Oddi Dysfunction with EUS-Guided Transjejunal ERCP: A Multimodal Endoscopic Approach

Abstract Text A 53-year-old patient with biliary pain, without biliary stones or duct dilation, was admitted with a suspected Oddi sphincter dysfunction. She had a complex history of sleeve gastrectomy, Roux-en-Y surgery, and gastrointestinal resections due to postoperative complications, leaving nearly no excluded stomach. Previous attempts at surgically assisted ERCP failed. An EUS-directed transgastric ERCP was planned, but no gastric pouch was identified. A LAMS was placed to create a jejuno-duodenal anastomosis, which was fixed with endoscopic sutures and dilated after 48 hours. A trans-anastomotic ERCP failed due to a scarred Vater's papilla. Early EUS-assisted rendezvous approach was attempted thought a hepatic hilum puncture and guidewire passage to the duodenum. A transjejunal-hepatic rendezvous technique allowed a successful ERCP with sphincterotomy and bile drainage.

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Publication History

Article published online:
27 March 2025