ASGE DDW Videos from Around the World | 2026-EUS-GUIDED TRANSENTERIC ACCESS ENABLING CHOLANGIOSCOPIC DIAGNOSIS AND MANAGEMENT OF SUTURE-INDUCED BILIARY OBSTRUCTION

EUS-GUIDED TRANSENTERIC ACCESS ENABLING CHOLANGIOSCOPIC DIAGNOSIS AND MANAGEMENT OF SUTURE-INDUCED BILIARY OBSTRUCTION

Video Transcription

Video Summary

A 57-year-old woman with complex altered anatomy and recurrent CBD obstruction after prior biliary surgery underwent EUS-guided enteroenteric lumen-oposing metal stent placement to create stable access for future biliary therapy. Weeks later, cholangioscopy revealed a CBD stone-like filling defect and mild stricture. Electrohydraulic lithotripsy exposed migrated surgical sutures causing the obstruction. The sutures were then cut and removed using laser-assisted cholangioscopy, with no leak seen on contrast study. A fully covered biliary stent was placed across the stricture. The case shows EUS-directed transenteric access enabling advanced endoscopic treatment of rare suture-induced biliary obstruction.

Asset Subtitle

Submitted by Kambiz Kadkhodayan

Keywords

EUS-guided enteroenteric lumen-oposing metal stent

biliary obstruction

cholangioscopy

electrohydraulic lithotripsy

laser-assisted suture removal