A Double-Guidewire Technique to Facilitate Deep Cannulation and Stenting in a Patient With Altered Gastrointestinal Anatomy

Hideaki Kawabata, Yuki Ueda, Yuji Okazaki, Misuzu Hitomi, Katsutoshi Yamaguchi, Yukino Kawakatsu, Masatoshi Miyata, Shigehiro Motoi

Abstract


Endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered gastrointestinal (GI) anatomy remains a challenging procedure. We experience particular difficulty passing a catheter and devices in patients who have biliary stricture or severe deformity, despite successful biliary guiding. A 70-year-old man with Roux-en-Y reconstruction for gastric cancer suffered pancreatic head cancer with biliary stricture. Seven months after biliary stenting, he developed acute occlusive suppressive cholangitis due to stent occlusion. We extracted the stent and inserted a guidewire into the intrahepatic bile duct. However, we were unable to pass the catheter due to severe stricture of the lower common bile duct and axis-dismatch between the bile duct and the catheter. After inserting another of the same guidewire into the bile duct, we were able to easily pass the catheter into the bile duct, resulting in the successful insertion of a new plastic stent. A double-guidewire technique is useful and worth attempting for the deep insertion of devices through biliary strictures in patients with an altered GI anatomy.




J Med Cases. 2019;10(1):1-3
doi: https://doi.org/10.14740/jmc3220

Keywords


Double-guidewire; Altered gastrointestinal anatomy; Endoscopic retrograde cholangiopancreatography

Full Text: HTML PDF
 

Browse  Journals  

 

Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

 

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

 

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

 

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

 

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 
       
 

Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org    elmer.editorial@hotmail.com
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.


Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.