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 Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

A 67−year−old man with a history of perfo− rated peptic ulcer, who had undergone a partial gastrectomy with a Billroth II anastomosis, developed acute cholecysti− tis and was referred for laparoscopic cho− lecystectomy. The common bile duct was accidentally transected during the chole− cystectomy, and a choledochojejunos− tomy was carried out. Subsequent cholan− giography clearly showed a progressive hilar stricture and dilation of the bilateral intrahepatic ducts. Metal Z−stents (Cook− Z Stent GZS−12 ± 6.0−CF, Cook Endoscopy, Winston−Salem, North Carolina, USA) were therefore inserted for percutaneous transhepatic cholangiographic drainage. Follow−up cholangiograms showed that the inserted metal stents had migrated distally to the tip of the Roux−en−Y intes− tinal loop (Figure 1). Removal of the mi− grated metal stents using conventional push enteroscopy (Olympus SIF−230, Olympus Corporation, Tokyo, Japan) was not successful. We therefore inserted a double−balloon enteroscope (Fujinon EN− 450T5, Fujinon, Tokyo, Japan) through the anastomosis of the choledochojeju− nostomy and successfully approached the migrated metal stent within the tip of the Roux−en−Y limb (Figure 2). Matsushita et al. described using an open biopsy forceps technique for endoscopic removal of migrated stents in four pa− tients [1]. However, if a migrated metal stent is located at the tip of a Roux−en−Y intestinal limb, this method is not suita− ble. Kuno et al. used the double−balloon technique to access the afferent duodenal loop in a patient with a Roux−en−Y gastro− jejunostomy; they carried out endoscopic mucosal resection of an early cancer in the terminal part of the afferent loop using the double−balloon technique [2]. The double−balloon enteroscope is the only instrument that is capable of passing through a Roux−en−Y anastomosis.

A new indication for double-balloon enteroscopy: removal of migrated metal stents through a Roux-en-Y anastomosis