Difficult case of endoscopic ultrasonography-guided choledochogastrostomy salvaged using a stiff guidewire
An 89-year-old woman presented to the hospital with a chief complaint of fever and hematuria. Computed tomography revealed left hydronephrosis due to bladder cancer, along with common bile duct stones and marked dilation of the bile duct. Endoscopic ultrasonography-guided choledochoduodenostomy was...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Society of Gastrointestinal Intervention
2025-01-01
|
| Series: | International Journal of Gastrointestinal Intervention |
| Subjects: | |
| Online Access: | https://www.ijgii.org/journal/view.html?doi=10.18528/ijgii240064 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832591264127647744 |
|---|---|
| author | Takio Narikawa Ken Kamata Takamitsu Komaki Mamoru Takenaka Masatoshi Kudo |
| author_facet | Takio Narikawa Ken Kamata Takamitsu Komaki Mamoru Takenaka Masatoshi Kudo |
| author_sort | Takio Narikawa |
| collection | DOAJ |
| description | An 89-year-old woman presented to the hospital with a chief complaint of fever and hematuria. Computed tomography revealed left hydronephrosis due to bladder cancer, along with common bile duct stones and marked dilation of the bile duct. Endoscopic ultrasonography-guided choledochoduodenostomy was attempted, but the common bile duct could not be visualized in close proximity to the duodenum. Instead, due to the gastroduodenal deformity, the common bile duct was in close proximity with the gastric antrum; therefore, the common bile duct was selected for puncture from the gastric antrum using a 19-gauge needle. However, the gastric wall and scope became separated during the dilation maneuver, making it difficult to dilate the fistula using a 6-Fr dilator and a 4-mm-diameter balloon dilation catheter, although it was possible to insert a tapered catheter with a 3.5-Fr tip under a 0.025-inch guidewire into the bile duct. The use of a stiff 0.035-inch guidewire allowed blunt dilation up to 9-Fr with a dilator, while simultaneously maintaining the distance between the gastric wall and the scope. Using this method, a 10-mm-diameter, 12-cm-long, partially covered metal stent was deployed successfully between the common bile duct and the posterior wall of the gastric antrum. Endoscopic ultrasonography-guided choledochogastrostomy (EUS-CGS) risks separating the gastrointestinal and biliary tracts during or after the procedure. In this case, the stiff guidewire enabled successful completion of the biliary procedures; thus, this guidewire can be used to safely manage difficult cases of EUS-CGS involving dilation of the fistula and stent deployment. |
| format | Article |
| id | doaj-art-ceecc8df564d4aeab6e19eda2e965b01 |
| institution | Kabale University |
| issn | 2636-0004 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Society of Gastrointestinal Intervention |
| record_format | Article |
| series | International Journal of Gastrointestinal Intervention |
| spelling | doaj-art-ceecc8df564d4aeab6e19eda2e965b012025-01-22T15:13:37ZengSociety of Gastrointestinal InterventionInternational Journal of Gastrointestinal Intervention2636-00042025-01-01141283110.18528/ijgii240064ijgii240064Difficult case of endoscopic ultrasonography-guided choledochogastrostomy salvaged using a stiff guidewireTakio Narikawa0Ken Kamata1Takamitsu Komaki2Mamoru Takenaka3Masatoshi Kudo4Department of Gastroenterology and Hepatology, Osaka Saiseikai Tondabayashi Hospital, Osaka, JapanDepartment of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, JapanDepartment of Gastroenterology and Hepatology, Osaka Saiseikai Tondabayashi Hospital, Osaka, JapanDepartment of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, JapanDepartment of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, JapanAn 89-year-old woman presented to the hospital with a chief complaint of fever and hematuria. Computed tomography revealed left hydronephrosis due to bladder cancer, along with common bile duct stones and marked dilation of the bile duct. Endoscopic ultrasonography-guided choledochoduodenostomy was attempted, but the common bile duct could not be visualized in close proximity to the duodenum. Instead, due to the gastroduodenal deformity, the common bile duct was in close proximity with the gastric antrum; therefore, the common bile duct was selected for puncture from the gastric antrum using a 19-gauge needle. However, the gastric wall and scope became separated during the dilation maneuver, making it difficult to dilate the fistula using a 6-Fr dilator and a 4-mm-diameter balloon dilation catheter, although it was possible to insert a tapered catheter with a 3.5-Fr tip under a 0.025-inch guidewire into the bile duct. The use of a stiff 0.035-inch guidewire allowed blunt dilation up to 9-Fr with a dilator, while simultaneously maintaining the distance between the gastric wall and the scope. Using this method, a 10-mm-diameter, 12-cm-long, partially covered metal stent was deployed successfully between the common bile duct and the posterior wall of the gastric antrum. Endoscopic ultrasonography-guided choledochogastrostomy (EUS-CGS) risks separating the gastrointestinal and biliary tracts during or after the procedure. In this case, the stiff guidewire enabled successful completion of the biliary procedures; thus, this guidewire can be used to safely manage difficult cases of EUS-CGS involving dilation of the fistula and stent deployment.https://www.ijgii.org/journal/view.html?doi=10.18528/ijgii240064bile canaliculicholangitisendosonography |
| spellingShingle | Takio Narikawa Ken Kamata Takamitsu Komaki Mamoru Takenaka Masatoshi Kudo Difficult case of endoscopic ultrasonography-guided choledochogastrostomy salvaged using a stiff guidewire International Journal of Gastrointestinal Intervention bile canaliculi cholangitis endosonography |
| title | Difficult case of endoscopic ultrasonography-guided choledochogastrostomy salvaged using a stiff guidewire |
| title_full | Difficult case of endoscopic ultrasonography-guided choledochogastrostomy salvaged using a stiff guidewire |
| title_fullStr | Difficult case of endoscopic ultrasonography-guided choledochogastrostomy salvaged using a stiff guidewire |
| title_full_unstemmed | Difficult case of endoscopic ultrasonography-guided choledochogastrostomy salvaged using a stiff guidewire |
| title_short | Difficult case of endoscopic ultrasonography-guided choledochogastrostomy salvaged using a stiff guidewire |
| title_sort | difficult case of endoscopic ultrasonography guided choledochogastrostomy salvaged using a stiff guidewire |
| topic | bile canaliculi cholangitis endosonography |
| url | https://www.ijgii.org/journal/view.html?doi=10.18528/ijgii240064 |
| work_keys_str_mv | AT takionarikawa difficultcaseofendoscopicultrasonographyguidedcholedochogastrostomysalvagedusingastiffguidewire AT kenkamata difficultcaseofendoscopicultrasonographyguidedcholedochogastrostomysalvagedusingastiffguidewire AT takamitsukomaki difficultcaseofendoscopicultrasonographyguidedcholedochogastrostomysalvagedusingastiffguidewire AT mamorutakenaka difficultcaseofendoscopicultrasonographyguidedcholedochogastrostomysalvagedusingastiffguidewire AT masatoshikudo difficultcaseofendoscopicultrasonographyguidedcholedochogastrostomysalvagedusingastiffguidewire |