Case Report
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World J Gastroenterol. Apr 7, 2011; 17(13): 1787-1790
Published online Apr 7, 2011. doi: 10.3748/wjg.v17.i13.1787
Application of a wire-guided side-viewing duodenoscope in total esophagectomy with colonic interposition
Chin-Yuan Yii, Jen-Wei Chou, Yen-Chun Peng, Wai-Keung Chow
Chin-Yuan Yii, Jen-Wei Chou, Wai-Keung Chow, Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan, China
Yen-Chun Peng, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40447, Taiwan, China
Author contributions: Yii CY and Chow WK contributed equally to this work; Chow WK performed the therapeutic ERCP; Chou JW and Peng YC critically revised the manuscript; Yii CY and Chow WK wrote the paper.
Correspondence to: Dr. Wai-Keung Chow, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, North District, Taichung 40447, Taiwan, China. wkchow2010@gmail.com
Telephone: +886-4-22052121 Fax: +886-4-22023119
Received: September 10, 2010
Revised: November 3, 2010
Accepted: November 10, 2010
Published online: April 7, 2011
Abstract

Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay treatment for bile duct disease. The procedure is difficult per se, especially when a side-viewing duodenoscope is used, and when the patient has altered anatomical features, such as colonic interposition. Currently, there is no consensus on the standard approach for therapeutic ERCP in patients with total esophagectomy and colonic interposition. We describe a novel treatment design that involves the use of a side-viewing duodenoscope to perform therapeutic ERCP in patients with total esophagectomy and colonic interposition. A gastroscope was initially introduced into the interposed colon and a radio-opaque standard guidewire was advanced to a distance beyond the papilla of Vater, before the gastroscope was withdrawn. A side-viewing duodenoscope was then introduced along the guidewire under fluoroscopic guidance. After cannulation into the papilla of Vater, endoscopic retrograde cholangiography (ERC) revealed a filling defect (maximum diameter: 15 cm) at the distal portion of the common bile duct (CBD). This defect was determined to be a stone, which was successfully retrieved by a Dormia basket after complete sphincterotomy. With this treatment design, it is possible to perform therapeutic ERCP in patients with colonic interposition, thereby precluding the need for percutaneous drainage or surgery.

Keywords: Wire-guided; Duodenoscope; Endoscopic retrograde cholangiopancreatography; Esophagectomy; Interposition of colon