Clinical Endoscopy

Case Reports

Portal cavernography during endoscopic retrograde cholangiopancreatography: from bilhemia to hemobilia: Rawad A. Yared, Paraskevas Gkolfakis, Arnaud Lemmers, Vincent Huberty, Thierry Degrez, Jacques Devière, Daniel Blero; Clin Endosc 2023;56(4):521-526. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2021.276

Portobiliary fistulas are rare but may lead to life-threatening complications. Biliary plastic stent-induced portobiliary fistulas during endoscopic retrograde cholangiopancreatography have been described. Herein, we present a case of portal cavernography and recurrent hemobilia after endoscopic retrograde cholangiopancreatography in which a portobiliary fistula was detected in a patient with portal biliopathy. This likely indicates a change in clinical presentation (from bilhemia to hemobilia) after biliary drainage that was successfully treated by placement of a fully covered, self-expandable metallic stent.

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Recognition and management of stent malposition in the portal vein during endoscopic retrograde cholangiopancreatography: A case report
Rui Wu, Feng Zhang, Hao Zhu, Ming-Dong Liu, Yu-Zheng Zhuge, Lei Wang, Bin Zhang
World Journal of Gastrointestinal Endoscopy.2024; 16(7): 432. CrossRef

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A Gastrobronchial Fistula Secondary to Endoscopic Internal Drainage of a Post-Sleeve Gastrectomy Fluid Collection: Paraskevas Gkolfakis, Marc-André Bureau, Marianna Arvanitakis, Jacques Devière, Daniel Blero; Clin Endosc 2022;55(1):141-145. Published online April 16, 2021; DOI: https://doi.org/10.5946/ce.2021.033

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A 44-year-old woman underwent sleeve gastrectomy, which was complicated by a leak. She was treated with two sessions of endoscopic internal drainage using plastic double-pigtail stents. Her clinical evolution was favorable, but four months after the initial stent placement, she became symptomatic, and a gastrobronchial fistula with the proximal end of the stents invading the diaphragm was diagnosed. She was treated with antibiotics, plastic stents were removed, and a partially covered metallic esophageal stent was placed. Eleven weeks later, the esophageal stent was removed with no evidence of fistula. Inappropriate stent size, position, stenting duration, and persistence of low-grade inflammation could explain the patient’s symptoms and provide a mechanism for gradual muscle rupture and fistula formation. Although endoscopic internal drainage is usually safe and effective for the management of post-laparoscopic sleeve gastrectomy leaks, close clinical and radiological follow-up is mandatory.

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Management of leakage and fistulas after bariatric surgery
Stephen A. Firkins, Roberto Simons-Linares
Best Practice & Research Clinical Gastroenterology.2024; 70: 101926. CrossRef
Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy
Alessandra D’Alessandro, Giovanni Galasso, Francesco Paolo Zito, Cristiano Giardiello, Fabrizio Cereatti, Roberto Arienzo, Filippo Pacini, Jean-Marc Chevallier, Gianfranco Donatelli
Obesity Surgery.2022; 32(2): 342. CrossRef

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