VideoGIE
All other authors disclosed no financial relationships relevant to this article. Kentaro Ishii, MD, Takao Itoi, MD, Takayoshi Tsuchiya, MD, Shuntaro Mukai, MD, Makoto Kohno, MD, Department of Gastroenterology
and Hepatology, Japan
Tokyo
Medical
University,
Tokyo,
http://dx.doi.org/10.1016/j.gie.2014.06.044
Magnetic compression anastomosis through EUS-guided choledochoduodenostomy to repair a disconnected bile duct in orthotopic liver transplantation
Figure 1. A, Balloon cholangiogram through the naked EUS-guided choledochoduodenostomy (EUS-CD) (large arrow) shows the cutoff at the disconnected choledochocholedochostomy (arrowhead). A covered self-expandable metal stent (SEMS) (small arrows) placed in the distal bile duct to facilitate magnet insertion at ERCP. B, Magnets across the disconnected segment with the SEMS across the EUS-CD and papilla. C, A patent newly formed biliary magnetic compression anastomosis. D, Retrograde retrieval of coupled magnets through the naked EUS-CD.
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. 520 GASTROINTESTINAL ENDOSCOPY Volume 80, No. 3 : 2014
2014 VIDEO FORUM WINNER Magnetic compression anastomosis (MCA) of the bile duct involves percutaneous access for proximal magnet insertion and retrieval. External biliary drainage is required during MCA formation. EUS-guided choledochoduodenostomy (EUS-CD) was used for magnet insertion during MCA in a patient who had undergone a liver transplantation. www.giejournal.org
VideoGIE
Obstructive jaundice developed in a 53-year-old man 3 years after orthotopic liver transplantation. Magnetic resonance imaging showed proximal biliary dilation and a disconnected duct at the choledochocholedochostomy. Retrograde guidewire access to the proximal duct during ERCP failed. EUS-CD with a covered self-expandable metal stent (SEMS) was performed. Antegrade guidewire passage through the mature EUS-CD (Video 1. Available online at www.giejournal.org; Fig. 1A) into the distal bile duct was also unsuccessful. Two 5 8-mm rare earth magnets were placed at each biliary stump, the proximal magnet through the naked EUS-CD and the distal magnet through a transpapillary SEMS. Another covered SEMS was placed across the EUS-CD to maintain biliary drainage (Fig. 1B). Ten days later, a retrograde cholangiogram showed a patent biliary MCA (Fig. 1C). The coupled magnets were retrieved in a retrograde fashion through the EUS-CD (Fig. 1D), and the newly formed biliary MCA was stented with a covered SEMS at ERCP. The patient is scheduled
to undergo periodic ERCP for stent replacement. EUS-guided anastomoses for biliary MCA instead of percutaneous tracks allow internalization of serial percutaneous intervention. DISCLOSURE All authors disclosed no financial relationships relevant to this article. Manuel Perez-Miranda, MD1, Nestor Aleman, MD1, Carlos de la Serna Higuera, MD1, Paula GilSimon, MD1, Baltasar Perez-Saborido, MD2, 1 Gloria Sanchez-Antolin, MD , Departments of Gastroenterology and Hepatology (1) and Surgery (2), Hospital Universitario Rio Hortega, Valladolid, Spain
http://dx.doi.org/10.1016/j.gie.2014.06.042
Too much to bear: endoscopic palliation of a duodenal fistula
Figure 1. A, Endoscopic view of a large fistula in the duodenal bulb. B, Endoscopic view of a fully covered, self-expandable, metal stent anchored to a PEG by use of a suture.
2014 VIDEO FORUM WINNER This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. www.giejournal.org
A 53-year-old woman underwent a laparoscopic cholecystectomy for suspected cholecystitis. Postoperatively, she was found to have high drain output. A large duodenal fistula was seen on endoscopy; pathology from the cholecystectomy revealed squamous cell carcinoma of the Volume 80, No. 3 : 2014 GASTROINTESTINAL ENDOSCOPY 521
All other authors disclosed no financial relationships relevant to this article. Kentaro Ishii, MD, Takao Itoi, MD, Takayoshi Tsuchiya, MD, Shuntaro Mukai, MD, Makoto Kohno, MD, Department of Gastroenterology
and Hepatology, Japan
Tokyo
Medical
University,
Tokyo,
http://dx.doi.org/10.1016/j.gie.2014.06.044
Magnetic compression anastomosis through EUS-guided choledochoduodenostomy to repair a disconnected bile duct in orthotopic liver transplantation
Figure 1. A, Balloon cholangiogram through the naked EUS-guided choledochoduodenostomy (EUS-CD) (large arrow) shows the cutoff at the disconnected choledochocholedochostomy (arrowhead). A covered self-expandable metal stent (SEMS) (small arrows) placed in the distal bile duct to facilitate magnet insertion at ERCP. B, Magnets across the disconnected segment with the SEMS across the EUS-CD and papilla. C, A patent newly formed biliary magnetic compression anastomosis. D, Retrograde retrieval of coupled magnets through the naked EUS-CD.
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. 520 GASTROINTESTINAL ENDOSCOPY Volume 80, No. 3 : 2014
2014 VIDEO FORUM WINNER Magnetic compression anastomosis (MCA) of the bile duct involves percutaneous access for proximal magnet insertion and retrieval. External biliary drainage is required during MCA formation. EUS-guided choledochoduodenostomy (EUS-CD) was used for magnet insertion during MCA in a patient who had undergone a liver transplantation. www.giejournal.org
VideoGIE
Obstructive jaundice developed in a 53-year-old man 3 years after orthotopic liver transplantation. Magnetic resonance imaging showed proximal biliary dilation and a disconnected duct at the choledochocholedochostomy. Retrograde guidewire access to the proximal duct during ERCP failed. EUS-CD with a covered self-expandable metal stent (SEMS) was performed. Antegrade guidewire passage through the mature EUS-CD (Video 1. Available online at www.giejournal.org; Fig. 1A) into the distal bile duct was also unsuccessful. Two 5 8-mm rare earth magnets were placed at each biliary stump, the proximal magnet through the naked EUS-CD and the distal magnet through a transpapillary SEMS. Another covered SEMS was placed across the EUS-CD to maintain biliary drainage (Fig. 1B). Ten days later, a retrograde cholangiogram showed a patent biliary MCA (Fig. 1C). The coupled magnets were retrieved in a retrograde fashion through the EUS-CD (Fig. 1D), and the newly formed biliary MCA was stented with a covered SEMS at ERCP. The patient is scheduled
to undergo periodic ERCP for stent replacement. EUS-guided anastomoses for biliary MCA instead of percutaneous tracks allow internalization of serial percutaneous intervention. DISCLOSURE All authors disclosed no financial relationships relevant to this article. Manuel Perez-Miranda, MD1, Nestor Aleman, MD1, Carlos de la Serna Higuera, MD1, Paula GilSimon, MD1, Baltasar Perez-Saborido, MD2, 1 Gloria Sanchez-Antolin, MD , Departments of Gastroenterology and Hepatology (1) and Surgery (2), Hospital Universitario Rio Hortega, Valladolid, Spain
http://dx.doi.org/10.1016/j.gie.2014.06.042
Too much to bear: endoscopic palliation of a duodenal fistula
Figure 1. A, Endoscopic view of a large fistula in the duodenal bulb. B, Endoscopic view of a fully covered, self-expandable, metal stent anchored to a PEG by use of a suture.
2014 VIDEO FORUM WINNER This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. www.giejournal.org
A 53-year-old woman underwent a laparoscopic cholecystectomy for suspected cholecystitis. Postoperatively, she was found to have high drain output. A large duodenal fistula was seen on endoscopy; pathology from the cholecystectomy revealed squamous cell carcinoma of the Volume 80, No. 3 : 2014 GASTROINTESTINAL ENDOSCOPY 521
