Endoscopy 2022; 54(05): E184-E185
DOI: 10.1055/a-1471-1444
E-Videos

Double-pigtail plastic stent is effective as a rescue therapy after obstruction of choledochoduodenostomy using a lumen-apposing metal stent

Jérémie Albouys
1   Gastroentérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
,
Sophie Geyl
1   Gastroentérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
,
Benjamin Redelsperger
1   Gastroentérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
,
Véronique Loustaud-Ratti
1   Gastroentérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
,
Romain Legros
1   Gastroentérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
,
Mathieu Pioche
2   Unité d’endoscopie digestive, Service de Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Jérémie Jacques
1   Gastroentérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
› Author Affiliations
 

Endoscopic ultrasound (EUS)-guided choledochoduodenostomy using a lumen-apposing metal stent (LAMS) is an effective alternative when endoscopic retrograde cholangiopancreatography fails or is impossible [1] [2] [3]. However, although the technique opens up new therapeutic possibilities, it is also associated with new complications, such as obstruction, for which an optimal treatment has not yet been clearly established [4].

We report the case of a 62-year-old patient with metastatic pancreatic adenocarcinoma of the liver exhibiting duodenal invasion. Initial management featured the insertion of a 6-mm LAMS (Hot AXIOS; Boston Scientific, Marlborough, Massachusetts, USA) to allow biliary drainage and a metallic duodenal stent (Wallflex; Boston Scientific) to treat the parietal and ampullary infiltration.

After 1 month, the patient presented with fever, abdominal pain, and jaundice suggestive of a LAMS obstruction. Gastroscopy revealed invasion of the duodenal stent and that the proximal flange of the LAMS was obstructed by food bezoars ([Fig. 1]). After the obstruction was cleared using a lavage pump, we placed a 7-Fr, 10-cm double-pigtail biliary stent (Boston Scientific) inside the LAMS ([Fig. 2, ] [Video 1]).

Zoom Image
Fig. 1 Gastroscopy revealed invasion of the duodenal stent and obstruction of the proximal flange of the lumen-apposing metal stent with bezoars.
Zoom Image
Fig. 2 Double-pigtail plastic stent in the lumen-apposing metal stent (view from the gastric antrum with transpyloric duodenal stent).

Video 1 Double-pigtail plastic stent placement is an effective rescue therapy after obstruction of a lumen-apposing metal stent placed during choledochoduodenostomy.


Quality:

Opacification evident at the end of the procedure confirmed permeability of the biliary and duodenal prostheses ([Fig. 3]). Over the following days, the biological jaundice and hyperthermia decreased, allowing resumption of chemotherapy.

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Fig. 3 Opacification showing permeability of the biliary and duodenal prostheses.

The addition of a double-pigtail, plastic biliary stent efficiently ensures LAMS patency, especially in cases of duodenal stenosis associated with risks of recurrent obstruction caused by bezoar impaction.

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Competing interests

J. Albouys is a consultant for Biogen. R. Legros is a consultant for Olympus and Boston Scientific and has received (ESD Training) from Erbe. V. Loustaud-Ratti is a speaker for Gilead and Abbvie. M. Pioche is a consultant for Olympus, Boston Scientific and 3D matrix and has received ESD training from Cook Medical and Olympus. J. Jacques is a consultant for Olympus, Boston Scientific and has received ESD Training from Erbe.


Corresponding author

Jérémie Albouys, MD
Service d’Hépato-gastro-entérologie
CHU Dupuytren
2 Avenue Martin Luther King
87042 Limoges
France   
Fax: +33-5-55-05-87-33   

Publication History

Publication Date:
12 May 2021 (online)

© 2021. Thieme. All rights reserved.

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Zoom Image
Fig. 1 Gastroscopy revealed invasion of the duodenal stent and obstruction of the proximal flange of the lumen-apposing metal stent with bezoars.
Zoom Image
Fig. 2 Double-pigtail plastic stent in the lumen-apposing metal stent (view from the gastric antrum with transpyloric duodenal stent).
Zoom Image
Fig. 3 Opacification showing permeability of the biliary and duodenal prostheses.