Advanced technical tips and recent insights in ERCP using balloon‐assisted endoscopy

Shimatani, Masaaki; Mitsuyama, Toshiyuki; Yamashina, Takeshi; Takeo, Masahiro; Horitani, Shunsuke; Saito, Natsuko; Matsumoto, Hironao; Orino, Masahiro; Kano, Masataka; Yuba, Takafumi; Takayama, Takuya; Nakagawa, Tatsuya; Takayama, Shoji

doi:10.1002/deo2.301

Cited by 2 publications

(3 citation statements)

References 59 publications

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“…The presence of a scar‐like mucosa surrounding the anastomosis can also serve as a clue for finding the anastomotic site. 1 …”

Section: Discussionmentioning

confidence: 99%

“…Managing such conditions requires precise identification of the stricture and sophisticated endoscopic techniques to administer effective treatment. 1 …”

Section: Discussionmentioning

confidence: 99%

“…Pancreatobiliary endoscopic interventions using balloon‐assisted endoscopes are the first‐line therapy for pancreatobiliary diseases in postoperative patients with reconstructed gastrointestinal anatomy. 1 However, there are many technical difficulties, and procedural completion rates vary widely among institutions, indicating that procedural techniques are yet to be standardized.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of direct needle puncture for complete hepaticojejunostomy anastomotic stricture after pancreaticoduodenectomy (with video)

Soga,

Hayakawa,

Fujiwara

et al. 2024

DEN Open

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A 79‐year‐old Japanese woman, who had undergone pancreaticoduodenectomy 6 months prior to presentation owing to pancreatic cancer, complained of jaundice with high fever. Computed tomography revealed proximal bile duct dilatation with complete hepaticojejunostomy anastomotic stricture (HJAS). We performed a single‐balloon endoscopy for biliary drainage. The presence of a scar‐like feature surrounding the anastomosis was identified as the HJAS. White‐light imaging during single‐balloon endoscopy revealed that the HJAS contained a milky whitish area (MWA), suggesting that a membranous and fibrosis layer affected continuous inflammation around the center of the anastomosis (within a scar‐like feature). Endoscopic dilatation was performed using an endoscopic injection needle, with the MWA used as an indicator. A 23‐gauge endoscopic injection needle was used to penetrate the center of the blind lumen within the MWA, and a pinhole was created in the stricture. After confirming the position of the proximal bile duct using a contrast medium with the needle, an endoscopic guidewire with a cannula was inserted into the pinhole. A through‐the‐scope sequential balloon dilator was used to dilate the stricture, and a plastic stent was inserted into the proximal bile duct. This endoscopic intervention led to positive outcomes. In cases of complete HJAS occlusion, an endoscopic approach to the bile duct is difficult because the anastomotic opening of the HJAS is not visible. Thus, puncturing within the MWA, which can be used as a scar‐like landmark within a complete membranous HJAS, is considered a useful endoscopic strategy.

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“…The presence of a scar‐like mucosa surrounding the anastomosis can also serve as a clue for finding the anastomotic site. 1 …”

Section: Discussionmentioning

confidence: 99%

“…Managing such conditions requires precise identification of the stricture and sophisticated endoscopic techniques to administer effective treatment. 1 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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