Strategic International Session2(JGES・JSGE・JSGS)
Fri. November 3rd   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
Troubleshooting of re-intervention after interventional EUS
Haruka Toyonaga1, Toshifumi Kin1, Akio Katanuma1
1Center for Gastroenterology, Teine Keijinkai Hospital
Background and aim:
While interventional endoscopic ultrasonography (IV-EUS) has been widely performed, the opportunity for re-intervention due to stent dysfunction is increasing. However, some cases involve technical difficulty in re-intervention as well as IV-EUS. Thus, we showed some cases with difficult re-intervention among 57 cases that underwent re-intervention in our center from January 2020 to March 2023 with videos.
Case presentations:
Case1 was cholangitis after EUS-guided hepaticogastrostomy (EUS-HGS) due the occlusion of the previously deployed metal stent (MS). We attempted to cut the gastric side of MS using argon plasma coagulation (APC). In this occasion, a 2-channel scope (GIF-2TQ260M, Olympus.Co., Japan) was used to fix MS with forceps during cutting MS with APC.
Case2 was recurrent cholangitis due to the obstruction at the cholangiojejunal anastomosis (CJ-a) after biliary drainage by EUS-HGS. We recanalized CJ-a by EUS-guided biliary drainage using a forward-viewing EUS that was inserted near CJ-a through afferent limb.
Case3 was pancreatitis due to the obstruction at the pancreatojejunal anastomosis (PJ-a) that was not detected on enteroscopic surveillance. We performed EUS-guided transmural pancreatic drainage initially, and tried recanalization of PJ-a after pancreatogastric anoastomosis was firm. In this re-intervention. we pierced PJ-s through pancreatic duct with the stiff back end of a guidewire.
Conclusions:The full consideration to the appropriate procedure along with the situation is important for the safe and successful re-intervention.
Index Term 1: Interventional EUS
Index Term 2: Troubleshooting
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