Under deep sedation with Propofol, the patient underwent ERCP that failed for a tight stricture of the second part of duodenum. During the procedure we decided to place a duodenal 6 cm Evolution stent (Cook Medical EVO-22-27-6-D) after a measurement of the length of stenosis with the guide catheter (Cook Medical SIS-10). The deployment of the Evolution stent under fluoroscopy was comfortable as usual.
After two days an ERCP was technically unsuccessful as the papilla was inaccessible despite probing within the duodenal stent. Thus, EUS-guided puncture was performed transgastrically into left intrahepatic ducts. A linear array echoendoscope was placed near the gastric lesser curve allowing visualization of a dilated left hepatic duct.
Dr. Francesco Di Matteo was not a paid consultant at the time of this publication.