Endoscopic ultrasound-guided gallbladder drainage in pancreatic cancer and cholangitis: A case report

• 作者: Alberto Larghi Barbara Omazzi Cristina Bezzio Desiree Picascia Enzo Domenico Mandelli Germana de Nucci Gianpiero Manes Ilaria Arena Nicola Imperatore
• 来源期刊: 世界胃肠内镜杂志:英文版(电子版)
• 学科: 医学
• 关键词: Gallbladder drainage Endoscopy ultrasound Pancreatic cancer CHOLANGITIS Case report Axios stent
• 年，卷（期）: 2020,（11）
• 页码范围: 488-492
• 页数: 5页
• 分类号: R57

摘要

BACKGROUND Head pancreatic cancers often present with clinical challenges requiring biliary drainage for chemotherapy or palliative scope.If usual endoscopic modalities fail or if percutaneous approach is not feasible,endoscopic ultrasound(EUS)guided biliary drainage can be considered.Here we describe and discuss an interesting clinical case in which EUS-guided gallbladder drainage(EUS-GBD)was chosen to treat acute severe cholangitis in a patient with advanced pancreatic cancer.CASE SUMMARY An 84-year-old female with a previous EUS-biopsy proven diagnosis of head pancreatic cancer presented with clinical signs of acute cholangitis.In September 2018 she had positioned a biliary and duodenal stent to relieve jaundice and an initial duodenal substenosis.In the emergency ward,an abdominal computed tomography scan showed proximal biliary stent occlusion due to neoplastic progression,but endoscopic retrograde cholangiopancreatography was impossible because of worsening duodenal stenosis and the absence of a chance to reach the Vater’s papilla area.EUS-guided choledocoduodenostomy was not technically feasible but because the cystic duct was free of neoplastic infiltration,an EUS-GBD using an Axios^TM stent was successfully performed.The patient started to feed after 48 h and was discharged 1 wk later.No other hospitalizations due to cholangitis or symptoms of Axios^TM stent occlusion/dysfunction were observed up until her death 6 mo later due to underlying disease.CONCLUSION This case demonstrated how different EUS therapeutic approaches could have a key role to treat critical and seemingly unsolvable situations and that they could play a more fundamental role in the next future.