Endoscopic ultrasound-assisted rendezvous technique followed by dual-duct drainage using a double-lumen papillotome: a salvage strategy for postendoscopic papillectomy stricture.

BACKGROUND AND AIMS: Papillary stricture is a clinically relevant late adverse event of endoscopic papillectomy (EP) and may result in concurrent cholangitis and pancreatitis. Although endoscopic drainage is the first-line modality, biliary and pancreatic duct access can be challenging because of fibrotic strictures after EP. This article aims to demonstrate the feasibility of EUS-assisted rendezvous (EUS-RV) combined with a double-lumen papillotome (MagicTome; PIOLAX Inc, Yokohama, Japan) to achieve dual-duct access.

METHODS

We present a case of a 70-year-old woman with cholangitis and pancreatitis caused by post-EP stricture. After a failed ERCP, a salvage EUS-RV was performed to access the biliary duct, followed by pancreatic duct cannulation using a double-lumen papillotome.

RESULTS

The distal bile duct was punctured from the duodenum with a 19-gauge needle (EZ Shot 3 Plus; Olympus, Tokyo, Japan), and a 0.025-inch guidewire (VisiGlide 2; Olympus) was advanced through the stricture into the duodenum. The guidewire was retrieved with biopsy forceps, and biliary access was established. Subsequently, using a double-lumen papillotome, we cannulated the pancreatic duct. Balloon dilation and plastic stent placement were performed in both ducts without adverse events. The stents were removed after 12 months. No recurrence was observed during 12 months of follow-up.

CONCLUSIONS

EUS-RV combined with a double-lumen papillotome is a useful salvage strategy for complete post-EP strictures. This method can be applied to difficult cannulation, particularly when dual-duct access is required.