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DOI: 10.1055/s-2006-944921
© Georg Thieme Verlag KG Stuttgart · New York
A new indication for double-balloon enteroscopy: removal of migrated metal stents through a Roux-en-Y anastomosis
Y. H. Yeh, M. D.
Division of Gastroenterology and Hepatology
Department of Internal Medicine
Show Chwan Memorial Hospital
542 Chung-Shan Road, Section 1
Changhua 500
Taiwan
Fax: +886-4-7233190
Email: medicalchu@yahoo.com.tw
Publication History
Publication Date:
04 July 2007 (online)
The rate of migration of metal stents is very low, but stents can be technically very difficult to remove if the patient has previously undergone biliary Roux-en-Y surgery. We report here on a case in which a migrated metal stent was removed using double-balloon enteroscopy - a new indication for the latter procedure.
A 67-year-old man with a history of perforated peptic ulcer, who had undergone a partial gastrectomy with a Billroth II anastomosis, developed acute cholecystitis and was referred for laparoscopic cholecystectomy. The common bile duct was accidentally transected during the cholecystectomy, and a choledochojejunostomy was carried out. Subsequent cholangiography clearly showed a progressive hilar stricture and dilation of the bilateral intrahepatic ducts. Metal Z-stents (Cook-Z Stent GZS-12 - 6.0-CF, Cook Endoscopy, Winston-Salem, North Carolina, USA) were therefore inserted for percutaneous transhepatic cholangiographic drainage. Follow-up cholangiograms showed that the inserted metal stents had migrated distally to the tip of the Roux-en-Y intestinal loop (Figure [1]). Removal of the migrated metal stents using conventional push enteroscopy (Olympus SIF-230, Olympus Corporation, Tokyo, Japan) was not successful. We therefore inserted a double-balloon enteroscope (Fujinon EN-450T5, Fujinon, Tokyo, Japan) through the anastomosis of the choledochojejunostomy and successfully approached the migrated metal stent within the tip of the Roux-en-Y limb (Figure [2]).
Matsushita et al. described using an open biopsy forceps technique for endoscopic removal of migrated stents in four patients [1]. However, if a migrated metal stent is located at the tip of a Roux-en-Y intestinal limb, this method is not suitable. Kuno et al. used the double-balloon technique to access the afferent duodenal loop in a patient with a Roux-en-Y gastrojejunostomy; they carried out endoscopic mucosal resection of an early cancer in the terminal part of the afferent loop using the double-balloon technique [2]. The double-balloon enteroscope is the only instrument that is capable of passing through a Roux-en-Y anastomosis.
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Endoscopy_UCTN_Code_CPL_1AI_2AD
References
- 1 Matsushita M, Takakuwa H, Nishio A. et al . Open-biopsy-forceps technique for endoscopic removal of distally migrated and impacted biliary metallic stents. Gastrointest Endosc. 2003; 58 924-927
- 2 Kuno A, Yamamoto H, Kita H. et al . Double-balloon enteroscopy through a Roux-en-Y anastomosis for EMR of an early carcinoma in the afferent duodenal limb. Gastrointest Endosc. 2004; 60 1032-1034
Y. H. Yeh, M. D.
Division of Gastroenterology and Hepatology
Department of Internal Medicine
Show Chwan Memorial Hospital
542 Chung-Shan Road, Section 1
Changhua 500
Taiwan
Fax: +886-4-7233190
Email: medicalchu@yahoo.com.tw
References
- 1 Matsushita M, Takakuwa H, Nishio A. et al . Open-biopsy-forceps technique for endoscopic removal of distally migrated and impacted biliary metallic stents. Gastrointest Endosc. 2003; 58 924-927
- 2 Kuno A, Yamamoto H, Kita H. et al . Double-balloon enteroscopy through a Roux-en-Y anastomosis for EMR of an early carcinoma in the afferent duodenal limb. Gastrointest Endosc. 2004; 60 1032-1034
Y. H. Yeh, M. D.
Division of Gastroenterology and Hepatology
Department of Internal Medicine
Show Chwan Memorial Hospital
542 Chung-Shan Road, Section 1
Changhua 500
Taiwan
Fax: +886-4-7233190
Email: medicalchu@yahoo.com.tw