- EUS-guided biliary drainage (EUS-BD) has been reported as a useful and safe salvage technique in cases of ERCP failure or inaccessible papilla. However, EUS-guided right hepatic bile duct drainage (EUS-RBD) remains challenging, although recent reports have described successful EUS-RBD with antegrade stenting or bypass stenting with conventional biliary metal stents. Recently we have developed a new single-pigtail plastic stent designed for EUS-BD. We describe 2 cases of EUS-RBD with use of the dedicated plastic stent.
- Recently, the efficacy of EUS-guided transrectal stent placement for pelvic abscess drainage has been reported, with good outcomes. However, there are several limitations of the transrectal drainage, such as insufficient drainage in case of a large abscess owing to a small-caliber stent or the possibility of stent migration. Herein, we describe EUS-guided pelvic abscess drainage with use of a biflanged metal stent through the perianal transgluteal route. A 69-year-old man with a 35-mm pelvic mass underwent EUS-guided FNA.
- A needle-knife papillotome (NKP) has been used instead of a standard sphincterotome knife for difficult endoscopic sphincterotomy (ES) in patients with a surgically altered anatomy such as Billroth II gastrectomy. However, use of an NKP may increase the risk of postprocedure pancreatitis because its tip is more directly in contact with the pancreatic duct, causing electric damage. The newly developed isolated-tip NKP (ITNKP) (Iso-Tome, second generation, MTW Endoskopie, Wesel, Germany) is a modified NKP that has a round tip made of sapphire to prevent electrical damage.
- Treatment of biliary calculi in patients with a surgically altered anatomy is often challenging despite the development of balloon enteroscopy (BE). To our knowledge, this is the first report of holmium: YAG laser lithotripsy (YAG-LL) via an EUS-guided hepaticogastrostomy (EUS-HGS) site for an impacted stone in the intrahepatic bile duct in a patient after pancreaticoduodenectomy (PD). An 80-year-old woman who underwent PD 6 years earlier for cancer of the pancreatic head presented with a high fever and abdominal pain due to repeated occurrences of cholangitis without the recurrence of cancer.
- Intrahepatic bile duct (IHBD) stones often occur in patients with surgical bilioenteric anastomosis. An endoscopic approach through the anastomosis is attempted first. If that is not possible, a percutaneous transhepatic approach is considered. Interventional EUS therapy for IHBD stones was recently reported as an alternative method. Herein we describe a novel extraction method for IHBD stones through a lumen-apposing biflanged metal stent (BFMS) placed at an EUS-guided choledochoduodenostomy site.
- Gastric outlet obstruction because of unresectable pancreatic cancer causes inadequate food intake with nausea and vomiting, leading to malnutrition and deterioration of quality of life. We previously reported on the feasibility and safety of EUS-guided balloon-occluded gastrojejunostomy bypass (EPASS) using a lumen-apposing metal stent (LAMS) and a special double-balloon enteric tube in an animal model. Herein, we introduce a successful case of EPASS (Fig. 1).
- Bleeding from the cavity caused by the rupture of a pseudoaneurysm is a fatal adverse event in patients with walled-off necrosis (WON). Thus, the management of bleeding is mandatory for treatment success. Herein, we describe a pulsating pseudoaneurysm in the cavity of a WON diagnosed by endoscopy through a fully covered biflanged metal stent (BFMS). Subsequently, the pseudoaneurysm was successfully treated.
- Choledochojejunostomy stenosis is one of the most problematic postsurgical adverse events in patients with Whipple resection. We present the successful treatment of this adverse event in such patients by using a lumen-apposing metal stent (LAMS).
- EUS-guided pancreatic duct (PD) stent placement is always challenging. Apart from EUS-guided biliary drainage, it may be more difficult to dilate the needle tract unless a cautery dilator is used because penetration of the parenchyma of the pancreas by the dilation catheter alone is an arduous task. Herein, we describe a successful case in which a Soehendra stent retrieval device (SSD; Cook Endoscopy, Winston-Salem, NC, USA) was very effective in dilating the needle tract without a cautery dilator in a patient who had undergone a Whipple resection.