An 81-year-old man underwent emergent ERCP because of acute cholangitis and sepsis.
During insertion of the duodenoscope, a tortuous esophagus with multiple tertiary
contractions, exfoliated mucosa, and a stenotic gastroesophageal junction was encountered.
Passage of the duodenoscope into the stomach proved impossible despite the use of
various guidewires. A forward-viewing esophagogastroduodenoscopy was then performed
and confirmed the previous findings; however, this scope could be passed with resistance
across a tight distal esophagus into the stomach and duodenum. Retroflexion in the
stomach showed a tight sphincter. The result of through-the-scope water-soluble esophagography
was consistent with achalasia (A). The scope was removed, and a gastric overtube (Guardus esophageal overtube, US
Endoscopy, Mentor, Ohio), inner diameter 16.7 mm, outer diameter 19.9 mm, was placed
into the oropharynx and through the esophagus under forward-viewing scope vision (B). The guiding and stabilizing overtube served as a giant working channel for the
duodenoscope to be advanced into the stomach and duodenum (C), allowing for a successful sphincterotomy with stone and pus extraction and stent
insertion (D).
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Publication history
Published online: January 20, 2016
Massimo Raimondo, MD, Associate Editor for Focal PointsIdentification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
