Percutaneous Transhepatic Holmium:YAG Laser Choledochojejunostomy for the Recanalization of Obstructed Surgical Anastomosis

Endo, Masayuki; Hashimoto, Masayuki; Ohuchi, Yasufumi; Ogawa, Toshihide; Iwamoto, Akemi; Noguchi, Naoya

doi:10.1016/j.jvir.2016.10.012

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…Direct needle puncture [6] should also be considered, but the skew relationship between B3 and B2 also made it difficult to directly puncture the lumen of B2 from a sheath placed in B3. Other recanalization techniques, such as radiofrequency puncture wires, yttrium aluminum garnet lasers, and compressing magnets, have been reported, all of which are off-label and not easy to apply [7][8][9]. The gunsight approach may be helpful for creating communication between two luminae that lie at acute angles to each other and have robust intervening structures.…”

Section: Discussionmentioning

confidence: 99%

A Case of Severe Biliary Anastomotic Stricture after Living Donor Liver Transplantation Successfully Treated Using the Modified Gunsight Technique with Two Balloon Catheters

Iwasawa

Tamura

Okamura

et al. 2021

Interventional Radiology

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Biliary stricture is a serious postoperative complication of liver transplantation. We report the case of a 2year-old boy with severe biliary anastomotic stricture after left lobe living donor liver transplantation. As cannulation from the occluded B3 into the jejunum was impossible using the conventional technique, a gunsight approach was utilized. By puncturing balloons dilated at the occluded site of B3 and the proximal end of the non-occlusive B2, a tract between B3 and B2 was created, and the catheter was finally successfully inserted from B3 into the jejunum through the dilated tract and B2. The gunsight approach is an option for severe biliary strictures when the conventional approach proves impossible.

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Section: Discussionmentioning

confidence: 99%

A Case of Severe Biliary Anastomotic Stricture after Living Donor Liver Transplantation Successfully Treated Using the Modified Gunsight Technique with Two Balloon Catheters

Iwasawa

Tamura

Okamura

et al. 2021

Interventional Radiology

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show abstract

“…The extraluminal recanalization for biliary obstruction using the stiff edge of a guide wire has been reported in patients who had failed intraluminal recanalization with conventional techniques using a catheter and guide wire [3]. On the other hand, various techniques of recanalization with off-label use of devices such as radiofrequency puncture wires, yttrium aluminum garnet lasers or compressing magnets, have been reported [4][5][6]. In the present case, the transseptal needle was utilized to create the extraluminal tract for the following reasons: (1) the curved shape of the distal end of the device allows for Fig.…”

Section: Discussionmentioning

confidence: 99%

Extraluminal recanalization for postoperative biliary obstruction using transseptal needle

et al. 2020

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Background Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. Case presentation A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. Conclusions Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.

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Benign postoperative hepaticojejunostomy stricture: percutaneous recanalisation using the reverse end of a microwire

et al. 2020

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Percutaneous Transhepatic Holmium:YAG Laser Choledochojejunostomy for the Recanalization of Obstructed Surgical Anastomosis

Cited by 5 publications

References 4 publications

A Case of Severe Biliary Anastomotic Stricture after Living Donor Liver Transplantation Successfully Treated Using the Modified Gunsight Technique with Two Balloon Catheters

A Case of Severe Biliary Anastomotic Stricture after Living Donor Liver Transplantation Successfully Treated Using the Modified Gunsight Technique with Two Balloon Catheters

Extraluminal recanalization for postoperative biliary obstruction using transseptal needle

Benign postoperative hepaticojejunostomy stricture: percutaneous recanalisation using the reverse end of a microwire

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