Gastrointestinal endoscopy · 2024
EUS-directed transduodenal ERCP in concomitant gastric outlet and biliary obstruction.
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Kesar Vivek, Abel William F, Bapaye Jay, Wasserman Reid D, Rozenberg Jonathan, Garikipati Subhash, Mönkemüller Klaus E, Kesar Varun, Yeaton Paul
Аннотация
BACKGROUND AND AIMS: Patients with concomitant gastric outlet obstruction (GOO) and biliary obstruction often have limited management options, particularly in the setting of severe debility. We detail the use of EUS-guided gastroduodenal placement of a lumen-apposing metal stent (LAMS) as a conduit for transduodenal ERCP: EUS-directed transduodenal ERCP.
METHODS: Nine patients who developed GOO with indwelling biliary metal stents or with anticipated biliary stent placement were retrospectively included.
RESULTS: A 20 mm × 10 mm LAMS was deployed for creation of gastroduodenostomy in all patients. ERCP was performed via the gastroduodenal LAMS with resolution of jaundice in 100% of patients. GOO score improved to 3 in all patients.
CONCLUSIONS: This study demonstrates excellent outcomes (resolution of jaundice and GOO) in all chronically ill, poor surgical candidates. Placement of a LAMS allowed for both treatment of GOO and ERCP access for present and future stent exchange.
METHODS: Nine patients who developed GOO with indwelling biliary metal stents or with anticipated biliary stent placement were retrospectively included.
RESULTS: A 20 mm × 10 mm LAMS was deployed for creation of gastroduodenostomy in all patients. ERCP was performed via the gastroduodenal LAMS with resolution of jaundice in 100% of patients. GOO score improved to 3 in all patients.
CONCLUSIONS: This study demonstrates excellent outcomes (resolution of jaundice and GOO) in all chronically ill, poor surgical candidates. Placement of a LAMS allowed for both treatment of GOO and ERCP access for present and future stent exchange.