Endoscopy 2018; 50(06): E144-E145
DOI: 10.1055/a-0588-4653
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Magnetic compression anastomosis for biliary obstruction after partial hepatectomy

Xue-Mei Jiang
1  Department of Gastroenterology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
,
Kenjiro Yamamoto
2  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Takayoshi Tsuchiya
2  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Atsushi Sofuni
2  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Shuntaro Mukai
2  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Yuichi Nagakawa
3  Third Department of Surgery, Tokyo Medical University, Tokyo, Japan
,
Takao Itoi
2  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
› Institutsangaben
Weitere Informationen

Corresponding author

Kenjiro Yamamoto, MD
Department of Gastroenterology and Hepatology, Tokyo Medical University
6-7-1 Nishishinjuku, Shinjuku-ku
Tokyo 160-0023, Japan
Fax: +81-3-53816654   

Publikationsverlauf

Publikationsdatum:
09.April 2018 (eFirst)

 

Magnetic compression anastomosis (MCA) is a revolutionary method of performing choledochocholedochostomy without surgery in patients with biliary obstruction [1] [2] [3] [4] [5]. Herein, we report the successful treatment, using MCA, of a case of complete biliary obstruction after partial hepatectomy.

A 64-year-old man who had undergone right partial hepatectomy for a metastatic liver tumor from rectal cancer was admitted to another hospital with bile leakage. Although the bile leakage was treated by endoscopic nasobiliary drainage, there was prolonged liver dysfunction, and computed tomography showed dilatation of the right-posterior intrahepatic bile duct ([Fig. 1]). Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage (PTBD) were attempted but recanalization was not possible ([Fig. 2]). Therefore, the patient was referred to our hospital.

Zoom Image
Fig. 1 Dilatation of the right-posterior intrahepatic bile (arrows) seen at computed tomography (CT).
Zoom Image
Fig. 2 Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage were attempted but recanalization was not possible.

Initially, an 18-Fr PTBD catheter was placed. A cylindrical neodymium magnet, 5 mm in diameter, was pushed to the tip of the PTBD catheter and inserted in the intrahepatic bile duct using biopsy forceps ([Video 1]). Next, another magnet, 3 mm in diameter, was inserted up to the tip of the inner part of the outer sheath of the guidewire (VisiGlide 2; Olympus, Tokyo, Japan) for delivery ([Fig. 3]). Then, the outer sheath with the magnet was inserted via the papilla and the magnet was pushed out using biopsy forceps. The magnets were advanced to sites immediately before and after the obstruction. Then, the two magnets were positioned so that they attracted each other ([Fig. 4], [Video 1]). A plastic stent was placed via the transpapillary route in the left bile duct to prevent magnet migration. Recanalization was achieved 7 days after the procedure and the magnets were endoscopically removed using basket forceps, without adverse events ([Fig. 5], [Video 1]). The created fistula was dilated using a 10-Fr biliary dilation catheter over the guidewire. Finally, a fully covered self-expandable metal stent (BonaStent M-intraductal; Standard Sci Tech, Seoul, South Korea) was placed in the right bile duct across the fistula ([Video 1]).

Video 1 Magnetic compression anastomosis for biliary obstruction following partial hepatectomy, after failure of recanalization by means of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage.


Qualität:
Zoom Image
Fig. 3 A magnet was inserted up to the tip of the lumen of the outer sheath of the guidewire for delivery.
Zoom Image
Fig. 4 The two magnets attracted each other.
Zoom Image
Fig. 5 Recanalization was achieved (main figure) and the magnets were endoscopically removed (inset).

Endoscopy_UCTN_Code_TTT_1AR_2AJ

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos


#

Competing interests

None


Corresponding author

Kenjiro Yamamoto, MD
Department of Gastroenterology and Hepatology, Tokyo Medical University
6-7-1 Nishishinjuku, Shinjuku-ku
Tokyo 160-0023, Japan
Fax: +81-3-53816654   


Zoom Image
Fig. 1 Dilatation of the right-posterior intrahepatic bile (arrows) seen at computed tomography (CT).
Zoom Image
Fig. 2 Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage were attempted but recanalization was not possible.
Zoom Image
Fig. 3 A magnet was inserted up to the tip of the lumen of the outer sheath of the guidewire for delivery.
Zoom Image
Fig. 4 The two magnets attracted each other.
Zoom Image
Fig. 5 Recanalization was achieved (main figure) and the magnets were endoscopically removed (inset).