ASGE DDW Videos from Around the World | 2023-EUS-DIRECTED TRANS-ENTERIC ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY WITH GIANT INTRAHEPATIC STONE LITHOTRIPSY AFTER LAMS-IN-LAMS RESCUE OF A MISDEPLOYMENT

EUS-DIRECTED TRANS-ENTERIC ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY WITH GIANT INTRAHEPATIC STONE LITHOTRIPSY AFTER LAMS-IN-LAMS RESCUE OF A MISDEPLOYMENT

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Video Transcription

Video Summary

The video discusses the case of an 80-year-old woman who had previously undergone a surgical procedure called Roux-en-Y hepatico-jejunostomy for complex choledocholithiasis (gallstones in the bile ducts). She was admitted for cholangitis (inflammation of the bile ducts) and had a large stone above the bilodigestive anastomosis (join between bile duct and digestive system). The video demonstrates the use of endoscopic ultrasound-directed transenteric endoscopic retrograde cholangiopancreatography (ERCP) to treat this condition. The procedure involves the deployment of various instruments, such as electrocautery, a lumen-opposing metal stent, and electrophoretic lithotripsy to break down the stone and achieve biliary clearance. This alternative procedure is considered for patients with Roux-en-Y hepatico-jejunostomy who require repeated biliary interventions. The video also highlights the potential complication of misdeployment of the lumen-apposing metal stent, which can be addressed through a "lumps-in-lumps rescue" strategy. Overall, the video provides insights into the endoscopic treatment options and challenges for patients with complex biliary conditions. No specific credits are granted for this video.

Asset Subtitle

World Cup
Authors: Giuseppe Vanella, Giuseppe Dell'Anna, Paolo G. Arcidiacono

Keywords

Roux-en-Y hepatico-jejunostomy

choledocholithiasis

cholangitis

endoscopic ultrasound-directed transenteric endoscopic retrograde cholangiopancreatography

biliary clearance