A case of EUS-guided choledochojejunostomy for severe hepaticojejunostomy anastomotic stricture

The patient was a 55-year-old woman who developed acute cholangitis due to a severe hepaticojejunostomy anastomotic stricture after undergoing pancreatoduodenectomy for pancreatic cancer. At the previous hospital, percutaneous transhepatic biliary drainage was performed to relieve cholangitis. The patient was referred to our hospital for an EUS-guided choledochojejunostomy (EUS-CJS). Using a forward-viewing echoendoscope, the common bile duct was visualized at the scarred anastomosis site and punctured with a 19-gauge needle. A double-lumen catheter was used to successfully insert guidewires into the hepatic ducts on both sides. After dilation of the anastomosis using a dilation balloon catheter, a fully covered self-expanding 10-mm diameter metallic stent and 7 Fr plastic stent were placed for the anastomotic stricture. No adverse events occurred during the procedure, the stent placement, or in the next 6 months. The stent was successfully removed, creating a firm fistula. The patient reported no fever or abdominal pain and had normal biochemical blood test results during the 7-month follow-up after stent removal. In conclusion, EUS-CJS using a forward-viewing echoendoscope may be a useful salvage procedure in cases with refractory anastomotic stricture.