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 Plus annual

Presents the access of premium content as premium feature

Premium Content

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 annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has been established as an alternative method of biliary drainage after failure of endoscopic retrograde cholangiopancreatography (ERCP) [1,2]. Because of its prolonged stent patency and reduced bile leakage, use of the covered self-expandable metallic stent (CSEMS) has recently been favored. We present a case of spontaneous dislocation of a partially covered SEMS (PCSEMS) after EUS-CDS that was successfully rescued by endoscopic intervention. A 67-year-old woman with metastatic cancer of the pancreatic head was admitted to our hospital with obstructive jaundice. She underwent EUS-CDS using a PCSEMS (WallFlex stent, 10×60 mm; Boston Scientific Japan, Tokyo, Japan) without complication (●" Video1). Seven months later, she developed acute cholangitis. The PCSEMS had dislocated, as was confirmed on computed tomography (●" Fig.1). Our first attempt was to try to extract the PCSEMS using a snare, but this failed because of tumor ingrowth into the uncovered portion. In our next attempt, the PCSEMS was partially trimmed using argon plasma coagulationwith an electrosurgical generator (ICC 200; Erbe Elektromedizin, Tübingen, Germany) at 80W and with a flow rate of 2L/min (●" Fig.2), and we attempted guidewire cannulation through thepartially fragmented PCSEMS. A 0.025-inch guidewire was advanced through the ERCP catheter under fluoroscopic guidance (●" Video2). ERC revealed a stricture of the PCSEMS caused by tumor ingrowth (●" Fig.3, ●" Video2). An ERCP catheter and a biliary dilation catheter could not be passed through the stricture (●" Video2). In our third attempt, we dilated the stricture using a 6-Fr wireguided diathermic dilator (Cysto-GastroSet; Endo-Flex, Voerde, Germany) using an EGS-100 electrosurgical generator (Olympus, Tokyo, Japan; 30W in pulse cut slowmode) (●" Fig.4,●" Video2). Finally, a 6-Fr uncovered SEMS (Zilver 635 stent; 10mm×60mm, Cook-Japan, Tokyo, Japan) was placed without complication (●" Fig.5,●" Video2). Fig.3 Radiograph showing spontaneous dislocation of the partially covered selfexpandable metallic stent and stricture of the stent due to tumor ingrowth.

endoscopy

Endoscopic salvage technique for spontaneous dislocation and tumor ingrowth of a partially covered, self-expandable metallic stent after endoscopic ultrasound-guided choledochoduodenostomy