Recanalization of a complete stenosis of biodesistive anastomosis by combined endoscope and interventional radiologic approach. A 74-year-old woman with head pancreatic adenocarcinoma submitted to a GTP presented complete stenosis of hepatogenic anastomosis two years after the surgery. Here we can see the complete stenosis and we use a pediatric colonoscopy to get there. And at the same time, the access to the bile tract was performed by transparietal access. The stenosis was located in the bifurcation of the liver ducts. The anastomosis was punctured by pushing the introduction catheter and the white guard was captured with a polypectomy loop. We can see the guide wire into the colonoscope. Now we are pulling the guide wire out. And we have to see if the local of the puncture is right. The radiologic image confirms that the position is very right. Now carefully we place a fully covered metal stand 10 mm x 6 cm in the local of the puncture. Now we are opening the stand with radiologic control. And, as you can see, with a good bile drainage. Here the stand is more closed. You can see that it is very open. And the radiologic image confirms that the stand is in a right position. With compress you can see a good drainage too. After 8 weeks, we can see the stand in the same right position and we use a biopsy forceps to take it out. Here is the stand in the stomach. And outside. We can see the aspect of the anastomosis. Here the aspect of the anastomosis. And in the same time we perform a balloon dilatation. We use radiologic control. Here is the final aspect of the anastomosis and the procedure was very well, with no complications.

pancreatic adenocarcinoma

stenosis

metal stent

bile drainage

balloon dilatation