Severe bleeding as a complication of endoscopic choledocho-duodenal drainage using LAMS (Hot-Axios) in the treatment of distal stenosis of the common bile duct due to pancreatic head adenocarcinoma

Abstract

Introduction: Endoscopic transpapillary drainage is a common method of solving malignant biliary obstruction. An alternative to the transpapillary approach is endosonographically guided biliary drainage using a lumen-apposition stent, which can be used not only in case of ERCP failure. Case report: We describe our experience with endosonographically guided choledocho-duodenal drainage using a lumen-apposition stent, which was complicated by delayed hemobilia. Persistent and severe bleeding was successfully resolved by endovascular embolization using a spiral coiling. Conclusion: Endosonographically guided drainage using a lumen-apposition stent may, despite all advantages, be accompanied by serious complications, including significant bleeding. Therefore, the availability of an interventional radiology unit is appropriate.