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Single Balloon Enteroscopy-Assisted ERCP Using Rendezvous Technique for Sharp Angulation of Roux-en-Y Limb in a Patient with Bile Duct Stones.

Itoi T, Ishii K, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Tsuji S, Umeda J, Moriyasu F - Diagn Ther Endosc (2010)

Bottom Line: Method.At first, a guidewire was passed antegradely through the major papilla after the needle puncture using percutaneous transhepatic biliary drainage technique.After a guidewire was firmly grasped by a snare forceps, it was pulled out of the body, resulting that the enteroscope could advance to the papilla.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.

ABSTRACT
The acute angulation of Roux-en-Y (R-Y) limb precludes endoscopic access for endoscopic retrograde cholangiopancreatography (ERCP) even using a balloon enteroscopy. Here, we describe a case of successful single balloon enteroscopy (SBE)-assisted ERCP using a rendezvous technique in a patient with sharply angulated R-Y limb in a 79-year-old woman who had bile duct stones. Method. At first, a guidewire was passed antegradely through the major papilla after the needle puncture using percutaneous transhepatic biliary drainage technique. A hydrophilic guidewire with an ERCP catheter was antegradely advanced beyond the Roux limb. After a guidewire was firmly grasped by a snare forceps, it was pulled out of the body, resulting that the enteroscope could advance to the papilla. After papillary dilation, complete removal of bile duct stones was achieved without any procedure-related complication. In conclusion, although further study is needed, SBE-assisted ERCP using a rendezvous technique may have a potential for selected patients.

No MeSH data available.


Related in: MedlinePlus

Rendezvous technique for acute angulation of Roux-en-Y limb. (a) X-ray film showed that a guidewire advanced over the Roux-en-Y limb. (b) Endoscopic imaging revealed that a guidewire reached the Roux-en-Y limb.
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fig1: Rendezvous technique for acute angulation of Roux-en-Y limb. (a) X-ray film showed that a guidewire advanced over the Roux-en-Y limb. (b) Endoscopic imaging revealed that a guidewire reached the Roux-en-Y limb.

Mentions: A 79-year-old woman who had total gastrectomy, with R-Y for gastric cancer, was admitted for the treatment of bile duct stones. Although we tried SBE-assisted ERCP (XSIF-Q260Y; Olympus Medical Systems, Tokyo, Japan), an enteroscope could not be advanced to sharply angulated R-Y limb. Three days later, we performed rendezvous technique-assisted SBE using carbon dioxide during the procedure. At first, a guidewire was passed antegradely through the major papilla after the needle puncture using a percutaneous transhepatic biliary drainage (PTBD) technique. A hydrophilic guidewire (Radifocus, Terumo, Tokyo, Japan) with an ERCP catheter was antegradely advanced beyond the Roux limb (Figures 1(a) and 1(b)).


Single Balloon Enteroscopy-Assisted ERCP Using Rendezvous Technique for Sharp Angulation of Roux-en-Y Limb in a Patient with Bile Duct Stones.

Itoi T, Ishii K, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Tsuji S, Umeda J, Moriyasu F - Diagn Ther Endosc (2010)

Rendezvous technique for acute angulation of Roux-en-Y limb. (a) X-ray film showed that a guidewire advanced over the Roux-en-Y limb. (b) Endoscopic imaging revealed that a guidewire reached the Roux-en-Y limb.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2821765&req=5

fig1: Rendezvous technique for acute angulation of Roux-en-Y limb. (a) X-ray film showed that a guidewire advanced over the Roux-en-Y limb. (b) Endoscopic imaging revealed that a guidewire reached the Roux-en-Y limb.
Mentions: A 79-year-old woman who had total gastrectomy, with R-Y for gastric cancer, was admitted for the treatment of bile duct stones. Although we tried SBE-assisted ERCP (XSIF-Q260Y; Olympus Medical Systems, Tokyo, Japan), an enteroscope could not be advanced to sharply angulated R-Y limb. Three days later, we performed rendezvous technique-assisted SBE using carbon dioxide during the procedure. At first, a guidewire was passed antegradely through the major papilla after the needle puncture using a percutaneous transhepatic biliary drainage (PTBD) technique. A hydrophilic guidewire (Radifocus, Terumo, Tokyo, Japan) with an ERCP catheter was antegradely advanced beyond the Roux limb (Figures 1(a) and 1(b)).

Bottom Line: Method.At first, a guidewire was passed antegradely through the major papilla after the needle puncture using percutaneous transhepatic biliary drainage technique.After a guidewire was firmly grasped by a snare forceps, it was pulled out of the body, resulting that the enteroscope could advance to the papilla.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.

ABSTRACT
The acute angulation of Roux-en-Y (R-Y) limb precludes endoscopic access for endoscopic retrograde cholangiopancreatography (ERCP) even using a balloon enteroscopy. Here, we describe a case of successful single balloon enteroscopy (SBE)-assisted ERCP using a rendezvous technique in a patient with sharply angulated R-Y limb in a 79-year-old woman who had bile duct stones. Method. At first, a guidewire was passed antegradely through the major papilla after the needle puncture using percutaneous transhepatic biliary drainage technique. A hydrophilic guidewire with an ERCP catheter was antegradely advanced beyond the Roux limb. After a guidewire was firmly grasped by a snare forceps, it was pulled out of the body, resulting that the enteroscope could advance to the papilla. After papillary dilation, complete removal of bile duct stones was achieved without any procedure-related complication. In conclusion, although further study is needed, SBE-assisted ERCP using a rendezvous technique may have a potential for selected patients.

No MeSH data available.


Related in: MedlinePlus