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  • An uncommon cause of common bile duct stenosis diagnosed and treated by cholangioscopy

  • Symptomatic benign distal biliary stricture in the setting of anomalous pancreaticobiliary junction treated with metal biliary and temporary plastic pancreatic stents

    A 35-year-old woman presented with abdominal pain and elevated liver enzymes. Her history included multiple ERCP procedures for choledocholithiasis and cholangitis, including cholangioscopy, plastic biliary stent placement, and balloon dilation once complicated by pancreatitis. Later imaging revealed a distal biliary stricture (BS) and an anomalous pancreaticobiliary junction (APBJ). The stricture, presumed to have resulted from recurrent inflammation, was benign after repeated cytologic assessment.
  • ERCP performed through previously placed duodenal stents: a multicenter retrospective study of outcomes and adverse events

    Background and Aims
    ERCP performed through previously placed enteral stents is an uncommon procedure without a significant amount of supporting literature and with a wide reported range of technical success. The purpose of this study was to evaluate and better define the technical feasibility and safety of performing ERCP through enteral stents in patients with combined malignant biliary and gastric outlet obstruction. Methods
    We conducted a multicenter, retrospective study on 71 patients with combined gastric outlet and biliary obstruction who underwent ERCP through a previously placed enteral stent at 2 tertiary care centers. Outcomes included but were not limited to technical success, clinical success, need for repeat ERCP, adverse events, and survival time. Results
    Overall technical success was achieved in 60 of 71 patients (85%), with technical success of 40 of 46 (87%) in type I obstructions (gastric outlet obstruction above the ampulla), 16 of 21 (76%) in type II obstructions (gastric outlet obstruction at the level of the ampulla), and 4 of 4 (100%) in type III obstructions (gastric outlet obstruction distal to the ampulla). In general, patients who achieved technical success also achieved clinical success. Adverse events occurred in 3 patients (3/71): 2 patients with acute cholangitis and 1 patient with perforation. Average survival time after the procedure was 4.6 months overall. Conclusions
    ERCP performed through enteral stents is safe, with a high technical and clinical success rate, but may be more technically challenging in the setting of type II obstructions. This procedure could be considered first line in the unique setting that a patient requires ERCP through a previously placed enteral stent for malignant gastric outlet and biliary obstruction.