Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2017; 9(3): 145-148
Published online Mar 16, 2017. doi: 10.4253/wjge.v9.i3.145
Endoscopic retrograde cholangiopancretography in modified double tracks anastomosis with anastomotic stenosis
Xiao-Song Wang, Fei Wang, Quan-Peng Li, Lin Miao, Xiu-Hua Zhang
Xiao-Song Wang, Fei Wang, Quan-Peng Li, Lin Miao, Xiu-Hua Zhang, Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Author contributions: Wang XS, Li QP and Zhang XH contributed equally to this work; all of the authors contributed to the patient care, data collection and analysis, and writing of this article.
Supported by the Key Research and Development Program of the Science and Technology Department, Jiangsu Province, China, No. BE2015722; and the Science and Technology Development Fund Project of Nanjing Medical University, Jiangsu Province, China, No. 2011NJMU246.
Institutional review board statement: The study was reviewed and approved by the Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University Institutional Review Board.
Informed consent statement: The patient involved in this study provided informed written consent.
Conflict-of-interest statement: The authors declare no conflict of interest exists in relation to the publication of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiu-Hua Zhang, MD, Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing 210011, Jiangsu Province, China. 1129wy@sina.com
Telephone: +86-25-58509932 Fax: +86-25-58509931
Received: November 13, 2016
Peer-review started: November 15, 2016
First decision: December 1, 2016
Revised: December 13, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: March 16, 2017
Processing time: 121 Days and 23.3 Hours
Abstract

A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d. The patient’s magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis. In his past history, he received proximal gastrectomy and modified double tracks anastomosis. Endoscopic retrograde cholangiopancretography in modified double tracks anastomosis, especially accompanied with anastomotic stenosis, has been rarely reported. In the present case, the duodenoscope was successfully introduced over the guidewire and the stone taken out using a basket. The patient had good palliation of his symptoms after removal of the stone.

Keywords: Endoscopic retrograde cholangiopancretography; Proximal gastrectomy; Modified double tracks anastomosis; Surgically altered gastrointestinal anatomy; Choledocholithiasis

Core tip: It has been quite difficult to carry out conventional endoscopic retrograde cholangiopancretography (ERCP) for pancreatobiliary diseases in patients with modified double tracks anastomosis after proximal gastrectomy. Thus, this procedure posed a great challenge to the endoscopist. After confirming the long limb, we chose to go back to the cabined anastomosis and switched the gastroscope for the duodenoscope. For safety, the endoscope that went into the residual stomach across the gastrojejunal anastomosis was introduced by guidewire. Finally, we successfully carried out the ERCP and removed the stone.