English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Tools annual

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Presents the access of premium content as premium feature

Premium Content

Global: Zendy Plus annual

Global: Zendy Free Plan

Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD)with placement of an electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has been increasingly used as an alternative treatment option in patients with distal malignant biliary obstruction and failed endoscopic retrograde cholangiopancreatography (ERCP) [1–3]. We report two cases of patients who have been referred to our unit for recurrence of obstructive jaundice after previous successful transpapillary metallic stent placement for distal malignant biliary obstruction. Case 1 was a 90-year-old woman with previous placement of a transpapillary, partially covered, biliary, self-expandable metal stent (SEMS; 40×10mm) for ampullary cancer, who presented 8 months later with recurrence of obstructive jaundice. Deep biliary cannulation by ERCP was impossible because of neoplastic duodenal infiltration, and proximal migration of the biliary SEMS was evident at fluoroscopy. EUS-guided antegrade rendezvous was unsuccessfully attempted following failure to advance the guidewire through the biliary stenosis into the duodenum. EUS-CD was then performed by transbulbar EC-LAMS (Hot Axios, 6 ×8mm; Boston Scientific, Marlborough, Massachusetts, USA) placement despite the presence of the biliary SEMS. Case 2 was an 81-year-old man with unresectable pancreatic cancer and previous placement of a biliary, uncovered SEMS (60×10mm), who presented after 9 months with gastric outlet obstruction and recurrence of obstructive jaundice. ERCP failed due to the presence of duodenal stenosis (▶Fig. 1). Therefore biliary drainage by a transbulbar EC-LAMS (6×8mm) was performed despite the presence of the indwelling biliary SEMS (▶Fig. 2, ▶Fig. 3). Duodenal SEMS (22× 60mm Wallflex Enteral; Boston Scientific) was then placed during the same endoscopic session (▶Fig. 4, ▶Video1). No procedure-related adverse events were reported and a significant decrease in total bilirubin level was registered in both patients. E-Videos

Endoscopic choledochoduodenostomy by lumen-apposing metal stent in jaundice recurrence after transpapillary metal stent placement