Removal of a broken percutaneous transhepatic biliary drainage catheter by cholangioscopy through a lumen-apposing metal stent used for choledochoduodenostomy

Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a lumen-apposing metal stent (LAMS) is an alternative procedure for biliary decompression in patients with distal malignant biliary strictures [1] [2] [3] [4]. Although this approach results in a new connecting passage into the bile duct, there are few reports of direct visualization into the bile duct through a LAMS used for CDS [5]. We present a procedure for the removal of a broken percutaneous transhepatic biliary drainage (PTBD) catheter through a LAMS used for CDS.

A 53-year-old woman with a history of schizophrenia was admitted with abdominal pain and jaundice. She had been diagnosed with pancreatic head cancer 1 month previously and underwent PTBD to decompress the malignant biliary strictures. Two days prior to admission, the patient had cut the PTBD catheter with a knife, after which she developed abdominal pain and jaundice. Computed tomography revealed the distal end of the broken catheter buried in the abdominal wall ([Fig. 1]). Removal of the catheter via a percutaneous tract was not possible.

Fig. 1 Computed tomographic scan showing the broken percutaneous transhepatic biliary drainage catheter buried in the abdominal wall.

Endoscopic retrograde cholangiopancreatography was also not possible, because pancreatic cancer had obstructed the second duodenal portion. Instead, EUS-CDS was performed using a LAMS (Spaxus; Taewoong Medical, Ilsan, South Korea). Four days later, direct peroral cholangioscopy using a multibending ultraslim endoscope (CHF-Y0010; Olympus Medical Systems, Tokyo, Japan) was performed through the LAMS ([Fig. 2 a, b]). Endoscopy revealed the broken catheter in the left intrahepatic bile duct. The catheter was grasped using a 2-mm forceps ([Fig. 2 c]) and successfully removed via endoscopic withdrawal through the LAMS ([Fig. 2 d]; [Video 1]).

Fig. 2 Removal of the broken percutaneous transhepatic biliary drainage (PTBD) catheter by direct peroral cholangioscopy using a multibending ultraslim endoscope through a lumen-apposing metal stent (LAMS). a, b Radiographic images showing (a) insertion of the multibending ultraslim endoscope into the intrahepatic duct through the LAMS and (b) withdrawal of the PTBD catheter through the LAMS. c Endoscopic image of the PTBD catheter being grasped by a 2-mm forceps. d The successfully removed broken PTBD catheter.

Video 1 Removal of a broken percutaneous transhepatic biliary drainage catheter by direct peroral cholangioscopy using a multibending ultraslim endoscope through a lumen-apposing metal stent used for choledochoduodenostomy.

This report describes the safe removal of a broken PTBD catheter via peroral cholangioscopy after EUS-CDS. The LAMS served as a connection route enabling a less invasive approach. The creation of an anastomosis between the enteric and biliary systems using a LAMS not only allows biliary drainage but also provides access for advanced endoscopic intervention.

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Publication History

Article published online:
16 January 2023

• References

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