Li YM, Yasen A, Chen SF, Fan J, Huang XB, Zuo GH, Zheng L. Endoscopic ultrasound-guided transhepatic antegrade stone removal for choledocholithiasis after pancreaticoduodenectomy: A case report and review of literature. World J Gastroenterol 2026; 32(8): 116856 [DOI: 10.3748/wjg.v32.i8.116856]
Corresponding Author of This Article
Lu Zheng, MD, PhD, Professor, Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Army Medical University, No. 183 Xinqiao High Street, Shapingba District, Chongqing 400037, China. zhenglu@tmmu.edu.cn
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Gastroenterology & Hepatology
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Case Report
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Feb 28, 2026 (publication date) through Feb 14, 2026
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World Journal of Gastroenterology
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1007-9327
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Li YM, Yasen A, Chen SF, Fan J, Huang XB, Zuo GH, Zheng L. Endoscopic ultrasound-guided transhepatic antegrade stone removal for choledocholithiasis after pancreaticoduodenectomy: A case report and review of literature. World J Gastroenterol 2026; 32(8): 116856 [DOI: 10.3748/wjg.v32.i8.116856]
World J Gastroenterol. Feb 28, 2026; 32(8): 116856 Published online Feb 28, 2026. doi: 10.3748/wjg.v32.i8.116856
Endoscopic ultrasound-guided transhepatic antegrade stone removal for choledocholithiasis after pancreaticoduodenectomy: A case report and review of literature
Yu-Ming Li, Aimaiti Yasen, Si-Fang Chen, Jian Fan, Xiao-Bing Huang, Guo-Hua Zuo, Lu Zheng, Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
Co-first authors: Yu-Ming Li and Aimaiti Yasen.
Co-corresponding authors: Guo-Hua Zuo and Lu Zheng.
Author contributions: Li YM, Yasen A, Zuo GH, Chen SF, Fan J, and Huang XB contributed to data collection; Li YM and Yasen A contributed to manuscript writing and editing as co-first authors; Zuo GH, Chen SF, Fan J, and Huang XB contributed to data analysis; Zheng L and Li YM contributed to conceptualization and supervision; Zheng L and Zuo GH contributed equally as co-corresponding authors. All the authors have read and approved the final manuscript.
Supported by Chongqing Science and Health Joint Medical Research Project, No. 2023MSXM140; and Youth Talent Project of the Second Affiliated Hospital of Army Medical University, No. 2022YQB044.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Lu Zheng, MD, PhD, Professor, Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Army Medical University, No. 183 Xinqiao High Street, Shapingba District, Chongqing 400037, China. zhenglu@tmmu.edu.cn
Received: November 24, 2025 Revised: December 7, 2025 Accepted: January 7, 2026 Published online: February 28, 2026 Processing time: 81 Days and 16.4 Hours
Abstract
BACKGROUND
The special choledocholithiasis (common hepatic duct stone) proximal to hepaticojejunostomy anastomosis following pancreaticoduodenectomy (PD) presents significant therapeutic challenges because of surgically altered anatomy, which precludes the use of conventional endoscopic retrograde cholangiopancreatography. Endoscopic ultrasound (EUS) offers a minimally invasive alternative for antegrade stone extraction. Here, we report a rare case of EUS-guided transhepatic antegrade stone removal (EUS-TASR) in a patient with choledocholithiasis occurring eleven years after PD.
CASE SUMMARY
A 58-year-old male with a history of PD for a duodenal tumor eleven years prior presented with a three-month history of intermittent upper abdominal discomfort. Imaging revealed a nodular filling defect in the common hepatic duct and mild intrahepatic biliary dilatation, confirming choledocholithiasis. Given the altered anatomy, endoscopic retrograde cholangiopancreatography was deemed unfeasible; thus, EUS-TASR with endoscopic nasobiliary drainage was successfully performed. The endoscopic nasobiliary drainage tube was removed on postoperative day 7, and the patient was discharged in stable condition on postoperative day 8. At the ten-month follow-up, the patient remained asymptomatic without complications.
CONCLUSION
EUS-TASR is a viable, minimally invasive approach for managing choledocholithiasis in post-PD patients with altered anatomy where conventional endoscopic access is restricted.
Core Tip: Endoscopic retrograde cholangiopancreatography is often anatomically impossible for choledocholithiasis after pancreaticoduodenectomy. This case highlights endoscopic ultrasound-guided transhepatic antegrade stone removal as a highly promising minimally invasive solution. By enabling precise puncture and single-session stone removal through a transgastric approach in surgically altered anatomy, endoscopic ultrasound-guided transhepatic antegrade stone removal avoids the need for multiple procedures or complex surgery, positioning it as a potential first-line therapy in such patients. Further studies are warranted to standardize this advanced technique.
