Itoi Takao, Ishii Kentaro, Sofuni Atsushi, Itokawa Fumihide, Kurihara Toshio, Tsuchiya Takayoshi, Tsuji Shujiro, Umeda Junko, Moriyasu Fuminori
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
Diagn Ther Endosc. 2009;2009:154084. doi: 10.1155/2009/154084. Epub 2010 Feb 14.
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.
Roux-en-Y（R-Y）肠袢的急性成角使得即使使用气囊小肠镜也无法进行内镜逆行胰胆管造影术（ERCP）的内镜进入。在此，我们描述了一例在一名79岁患有胆管结石且R-Y肠袢急剧成角的女性患者中，使用会师技术成功进行单气囊小肠镜（SBE）辅助ERCP的病例。方法。首先，在经皮经肝胆道引流技术穿刺后，一根导丝经乳头顺行穿过。一根带有ERCP导管的亲水导丝顺行推进至超过Roux肠袢。在用圈套器牢固抓住导丝后，将其从体内拉出，使得小肠镜能够推进至乳头。乳头扩张后，成功完全清除胆管结石，且无任何与操作相关的并发症。总之，尽管需要进一步研究，但使用会师技术的SBE辅助ERCP可能对特定患者具有潜力。
