Hybrid Surgical and Endoscopic Transjejunal ERCP approach for Intra-Hepatic Biliary Stones Secondary to Recurrent Roux-En-Y Hepaticojejunal Anastomotic Strictures

Nolasco Vaz J1*, Faria A1 , Gaio R2 , Maria B1 , Felicio C1 , Noronha Ferreira C3 , Carrilho-Ribeiro L3 , Tato Marinho R3 and Coutinho J1,3

Department of General Surgery, Centro Hospitalar Universitário Lisboa Norte, Portugal 2 Department of Radiology, Centro Hospitalar Universitário Lisboa Norte, Portugal 3 Department of Gastroenterology, Centro Hospitalar Universitário Lisboa Norte, Portugal

^*Correspondance to: Nolasco Vaz J 

 PDF  Full Text DOI: 10.25107/2474-1647.3109

Abstract

Hepaticojejunal anastomotic stricture can result in intra-hepatic biliary stones and recurrent cholangitis. In the presence of altered small bowel anatomy, therapeutic ERCP has a low success rate. In patients with gastric bypass, there is increased expertise and efficiency in performing ERCP through transgastric access. Transjejunal access is an alternative in the absence of a gastric remnant. We present a case of a 30-years-old female with recurrent cholangitis and intra-hepatic biliary stones resulting from hepaticojejunal anastomotic stricture. The presence of severe adhesions between jejunal loops resulted in failure of double balloon enteroscopy assisted ERCP. A hybrid surgicalendoscopic approach via transjejunal enterotomy allowed access to hepaticojejunal anastomotic stricture which was dilated with through the scope balloon and subsequent removal of multiple biliary stones. A hybrid surgical-endoscopic transjejunal ERCP is a feasible approach after failure of other conventional endoscopic approaches to manage patients with hepaticojejunal anastomotic strictures

Keywords

Transjejunal ERCP; Roux-en-Y; Hepaticojejunal anastomotic strictures; Intrahepatic biliary stones

Cite the article

Nolasco Vaz J, Faria A, Gaio R, Maria B, Felicio C, Noronha Ferreira C, et al. Hybrid Surgical and Endoscopic Transjejunal ERCP approach for IntraHepatic Biliary Stones Secondary to Recurrent Roux-En-Y Hepaticojejunal Anastomotic Strictures. Clin Surg. 2021; 6: 3109..