If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
An 85-year-old woman underwent right hepatectomy with choledochojejunostomy because
of a diagnosis of hepatocellular carcinoma 1 year earlier. She was admitted to our
hospital because of frequent cholangitis. On CT, intrahepatic bile duct dilatation
and stones were seen. She had dementia, so a percutaneous approach was contraindicated
because of the risk of her removing the tube. A surgical approach was also a contraindication
because of her older age and dementia. A transgastric approach was therefore selected.
First, EUS-guided hepaticogastrostomy (HGS) was performed, during which we determined
whether the cholangiocarcinoma was complicated, and we attempted to remove the stones
(Video 1, available online at www.giejournal.org). An ERCP catheter was inserted into the bile duct through an EUS-HGS stent, and
contrast medium was injected. Cholangiography showed multiple defects in the left
intrahepatic bile duct (Fig. 1A). The cholangioscope was then inserted into the intrahepatic bile duct through the
EUS-HGS stent (Fig. 1B). Although multiple stones were seen, the mucosa of the intrahepatic bile duct was
clear and smooth. Next, a basket catheter was inserted, and the stones were successfully
removed (Fig. 1C). There were no adverse events associated with this procedure. If a patient with
an intrahepatic bile duct stone cannot be treated by a surgical or percutaneous approach
because of dementia or other factors, our technique has clinical impact.
Figure 1A, Cholangiographic view showing multiple defects suspected to represent stones. B, Stent trimming performed with diathermic dilator. C, Successful removal of intrahepatic bile duct stones with a basket catheter.
