Successful biliary drainage using a metal stent through the gastric stoma

Abstract

We report a case of biliary drainage for malignant stricture using a metal stent with an ultrathin endoscope through the gastric stoma. A 78-year-old female was referred to our hospital for jaundice and fever. She had undergone percutaneous endoscopic gastrostomy (PEG) for esophageal obstruction after radiation therapy for cancer of the pharynx. Abdominal contrast-enhanced computed tomography showed a 3-cm enhanced mass in the middle bile duct and dilatation of the intra-hepatic bile duct. We initially performed endoscopic retrograde cholangiopancreatography (ERCP) with a trans-oral approach. However, neither the side-viewing endoscope nor the ultrathin endoscope passed through the esophageal orifice. Thus, we eventually performed ERCP via the PEG stoma using an ultrathin endoscope. We performed biliary drainage with a 6F introducer self-expanding metal stent. The cytology findings obtained by brush cytology showed malignancy. Her laboratory results were restored to normal levels after drainage and no complication occurred.

Keywords: Percutaneous endoscopic gastrostomy; Transgastrostomic endoscopy; Ultrathin endoscope; Malignant biliary obstruction; Metal stent

Core tip: The method of transgastrostomic endoscopy using an ultrathin endoscope has been reported in terms of its safety and various advantages. A 6F delivery system uncovered-type self-expanding metal stent (SEMS) has been developed, and this SEMS is able to pass through an endoscopic working channel at least 2.0 mm in diameter. To our knowledge, this is the first reported evaluation of the performance of biliary drainage for malignant stricture using a 6F introducer SEMS with an ultrathin endoscope through the percutaneous endoscopic gastrostomy stoma.