Unique Approach to Managing Hepatojejunal Anastomotic Stricture in a Patient With a Long Roux-en-Y Limb.

An anastomotic stricture is a frequent adverse outcome in patients with a Roux-En-Y hepaticojejunostomy. The patient described in this article developed a complicated hepato-jejunal anastomotic stricture with intrahepatic stones that could not be treated with standard balloon enteroscopic interventions due to a very long Roux limb. Thus, a duodenojejunostomy was created to allow access to the stricture and manage the intrahepatic stones. In this case, we convened a multidisciplinary panel of radiologists, surgeons, and interventional endoscopists to consider various therapeutic approaches. The various options were discussed with the patient as part of patient-centered medical decision-making. This patient case highlights the evolving and expanding role of endoscopic ultrasound-directed transenteric interventions for obtaining durable luminal access in patients with altered foregut anatomy, thus providing another avenue for therapeutic interventions which avoid surgery and associated morbidity.