Tomooka Fumimasa, Kitagawa Koh, Mitoro Akira, Motokawa Yuki, Takami Masayoshi, Asada Shohei, Nishimura Norihisa, Ozutsumi Takahiro, Fujinaga Yukihisa, Yoshiji Hitoshi
Department of Gastroenterology, Nara Medical University, Nara, Japan.
Division of Endoscopy, Nara Medical University, Nara, Japan.
SAGE Open Med Case Rep. 2023 Sep 12;11:2050313X231200290. doi: 10.1177/2050313X231200290. eCollection 2023.
A male patient underwent gastrojejunal bypass surgery in 2017. In 2020, he was referred to our hospital for suspected obstructive jaundice. Subsequently, he was diagnosed with cholangiocarcinoma, and endoscopic retrograde cholangiopancreatography was attempted via balloon-assisted enteroscopy. However, the endoscope did not reach the duodenal papilla owing to the abdomen-small intestine adhesion. Therefore, endoscopic ultrasound-guided hepaticogastrostomy was performed using a dedicated plastic stent. After stent placement, obstructive jaundice and cholangitis promptly improved. However, we replaced the plastic stent with a fully covered self-expandable metal stent because stent occlusions occurred frequently. Two months after fully covered self-expandable metal stent placement, the patient developed cholangitis again. Notably, during the endoscopic procedure, the stent was found to be completely migrated. Nevertheless, the fistula was still open, and the patient was successfully retreated with the maintained fistula of endoscopic ultrasound-guided hepaticogastrostomy.
一名男性患者于2017年接受了胃空肠旁路手术。2020年，他因疑似梗阻性黄疸被转诊至我院。随后，他被诊断为胆管癌，并尝试通过球囊辅助肠镜进行内镜逆行胰胆管造影。然而，由于腹部与小肠粘连，内镜未能到达十二指肠乳头。因此，使用专用塑料支架进行了内镜超声引导下肝胃造瘘术。支架置入后，梗阻性黄疸和胆管炎迅速改善。然而，由于支架频繁堵塞，我们用完全覆盖的自膨式金属支架替换了塑料支架。在置入完全覆盖的自膨式金属支架两个月后，患者再次发生胆管炎。值得注意的是，在内镜检查过程中，发现支架已完全移位。尽管如此，瘘管仍然开放，患者通过维持内镜超声引导下肝胃造瘘术的瘘管成功接受了再次治疗。
