VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Novel endoscopic approach for a large intraluminal duodenal (“windsock”) diverticulum
Figure 1. Endoscopic images of an intraluminal duodenal (“windsock”) diverticulum before and after diverticulotomy. A, The 4-cm diverticulum can be seen in the second part of the duodenum. B, Disruption of the diverticulum after cutting over a fully covered self-expandable metallic stent.
A 59-year-old woman presented for evaluation of recurrent acute pancreatitis over 8 years and had previously undergone a cholecystectomy. Additionally, she had a longstanding history of foregut symptoms with multiple prior upper endoscopies not identifying an abnormality. Cross-sectional imaging revealed a dilated common bile duct with no mass seen on EUS. At attempted ERCP, a structure was identified that was in the correct location for the major papilla but was odd in appearance. This was subsequently found to be a large intraluminal duodenal “windsock” diverticulum (Fig. 1). The actual major papilla was identified, and she underwent ERCP and biliary sphincterotomy. Despite this, her symptoms persisted. A diverticulotomy was subsequently arranged. A through-the-scope 18 80 mm fully covered selfexpandable metallic stent was inserted into the diverticulum in such a manner that the distal end exited into the true lumen of the second part of the duodenum. The septum was cut with a needle-knife, care being taken to cut toward and onto the stent. At completion of the procedure, only 1 lumen existed (Video 1, available online at
www.giejournal.org
www.giejournal.org). Follow-up endoscopy at 6 months revealed 1 lumen, and the patient’s symptoms resolved. This account demonstrates a novel endoscopic technique to obliterate a symptomatic intraluminal duodenal septum. DISCLOSURE Dr Khashab is a consultant for Boston Scientific, Xlumena, and Olympus America and has received research support from Cook Medical. All other authors disclosed no financial relationships relevant to this publication. Vivek Kumbhari, MD, Alan H. Tieu, MD, Alba Azola, MD, Saowanee Ngamreunphong, MD, Mohamad H. El Zein, MD, Mouen A. Khashab, MD, Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
http://dx.doi.org/10.1016/j.gie.2015.05.055
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
Novel endoscopic approach for a large intraluminal duodenal (“windsock”) diverticulum
Figure 1. Endoscopic images of an intraluminal duodenal (“windsock”) diverticulum before and after diverticulotomy. A, The 4-cm diverticulum can be seen in the second part of the duodenum. B, Disruption of the diverticulum after cutting over a fully covered self-expandable metallic stent.
A 59-year-old woman presented for evaluation of recurrent acute pancreatitis over 8 years and had previously undergone a cholecystectomy. Additionally, she had a longstanding history of foregut symptoms with multiple prior upper endoscopies not identifying an abnormality. Cross-sectional imaging revealed a dilated common bile duct with no mass seen on EUS. At attempted ERCP, a structure was identified that was in the correct location for the major papilla but was odd in appearance. This was subsequently found to be a large intraluminal duodenal “windsock” diverticulum (Fig. 1). The actual major papilla was identified, and she underwent ERCP and biliary sphincterotomy. Despite this, her symptoms persisted. A diverticulotomy was subsequently arranged. A through-the-scope 18 80 mm fully covered selfexpandable metallic stent was inserted into the diverticulum in such a manner that the distal end exited into the true lumen of the second part of the duodenum. The septum was cut with a needle-knife, care being taken to cut toward and onto the stent. At completion of the procedure, only 1 lumen existed (Video 1, available online at
www.giejournal.org
www.giejournal.org). Follow-up endoscopy at 6 months revealed 1 lumen, and the patient’s symptoms resolved. This account demonstrates a novel endoscopic technique to obliterate a symptomatic intraluminal duodenal septum. DISCLOSURE Dr Khashab is a consultant for Boston Scientific, Xlumena, and Olympus America and has received research support from Cook Medical. All other authors disclosed no financial relationships relevant to this publication. Vivek Kumbhari, MD, Alan H. Tieu, MD, Alba Azola, MD, Saowanee Ngamreunphong, MD, Mohamad H. El Zein, MD, Mouen A. Khashab, MD, Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
http://dx.doi.org/10.1016/j.gie.2015.05.055
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
