Endoscopy 2019; 51(07): E199-E200
DOI: 10.1055/a-0881-2667
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© Georg Thieme Verlag KG Stuttgart · New York

Coil valve syndrome: a rare complication of percutaneous transhepatic obliteration successfully treated by argon plasma coagulation and double-balloon endoscopy

Koji Nagaike
1   Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
,
Shiro Hayashi
2   Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Osaka, Japan
,
Kengo Nagai
1   Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
,
Hirokazu Sasakawa
1   Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
,
Kiyonori Yuguchi
1   Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
,
Yuichi Yoshida
1   Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
,
Masafumi Naito
1   Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
› Author Affiliations
Further Information

Corresponding author

Koji Nagaike, MD
Department of Gastroenterology and Hepatology, Suita Municipal Hospital
5-7 Kishibeshinmachi
Osaka 564-8567
Japan   
Fax: +81-6-63805825   

Publication History

Publication Date:
12 April 2019 (online)

 

Percutaneous transhepatic obliteration (PTO) is now widely used for prophylactic treatment of gastric varices [1]. A straying coil tip in the stomach is sometimes reported as an adverse event [2] [3], but there have been no reports of one reaching the small intestine from the stomach.

In this case, the migrated coil tip with food residue was shaped like a ball and passed into the jejunum, causing a phenomenon resembling ball valve syndrome [4].

A 70-year-old woman was admitted with epigastric pain. She had been treated for gastric varices by PTO with coils ([Fig. 1]) 4 years earlier. One of these had migrated into the stomach asymptomatically 1 year after PTO ([Fig. 2]) and had been carefully monitored. Esophagogastroduodenoscopy on admission revealed the coil extending through the stomach and hooking into the mucosa at the angular portion of the stomach ([Fig. 3]). Abdominal computed tomography revealed that the coil tip was now in the jejunum ([Fig. 4]). Because of the risks of ulceration, perforation, or intussusception, we decided to remove it. Oral double-balloon enteroscopy (DBE) detected the coil tip enveloped by food residue in the jejunum; we carefully grasped it using forceps and pulled it back into the stomach. At first, we failed to cut the coil wire using a scissor-type electrical knife and loop cutter, but we finally succeeded in cutting it using argon plasma coagulation (APC) ([Video 1]). There were no adverse events during this procedure and the patient’s symptoms improved.

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Fig. 1 Cerecyte coil.
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Fig. 2 Endoscopic view of coil used to treat gastric varices, migrating from the fornix of the stomach (arrow).
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Fig. 3 Endoscopic view of a migrated coil biting into the mucous membrane at the angular portion of the stomach.
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Fig. 4 Computed tomography (CT) confirmed that the end of the coil was in the jejunum.

Video 1 “Coil valve syndrome”: a rare complication of percutaneous transhepatic obliteration for gastric varices that was successfully treated by argon plasma coagulation (APC) and double-balloon endoscopy (DBE).

The recovered coil was an 82-cm cerecyte coil. It was only possible to cut it using APC because the coil wire had unraveled and lengthened ([Fig. 5]). Compared with radiologists, few gastroenterologists know about migrated PTO coils and their characteristics.

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Fig. 5 The recovered unraveled 82-cm cerecyte coil.

This case shows a rare complication of PTO that was successfully treated by APC and DBE. We propose to describe this “coil valve syndrome” as “ball valve-like syndrome due to deviated coil.”

Endoscopy_UCTN_Code_CPL_1AK_2AH

Correction

Koji Nagaike, Shiro Hayashi, Kengo Nagai et al. Coil valve syndrome: a rare complication of percutaneous transhepatic obliteration successfully treated by argon plasma coagulation and double-balloon endoscopy. Endoscopy 2019, doi:10.1055/a-0881-2667
In the above-mentioned article, the name of the author Yuichi Yoshida has been corrected. This was corrected in the online version on May 27, 2019.


Competing interests

None


Corresponding author

Koji Nagaike, MD
Department of Gastroenterology and Hepatology, Suita Municipal Hospital
5-7 Kishibeshinmachi
Osaka 564-8567
Japan   
Fax: +81-6-63805825   


Zoom
Fig. 1 Cerecyte coil.
Zoom
Fig. 2 Endoscopic view of coil used to treat gastric varices, migrating from the fornix of the stomach (arrow).
Zoom
Fig. 3 Endoscopic view of a migrated coil biting into the mucous membrane at the angular portion of the stomach.
Zoom
Fig. 4 Computed tomography (CT) confirmed that the end of the coil was in the jejunum.
Zoom
Fig. 5 The recovered unraveled 82-cm cerecyte coil.