At the focal point| Volume 84, ISSUE 3, P539-540, September 2016

Salvage ERCP using overtube-assisted technique in a patient with cholangitis and esophageal stenosis due to achalasia

Published:January 20, 2016DOI:
      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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