Therapeutic single balloon enteroscopy used for treatment of stenosis of hepatico-jejunoanastomosis on Roux-en-Y Loop

Česká verze

Authors: I. Novotný; Petr Dítě
Authors place of work: Interní hepatogastroenterologická klinka FN Brno
Published in the journal: Gastroent Hepatol 2010; 64(3): 13-17
Category: Endoskopie

Summary

Enteroscopy allows the diagnosis and treatment of any part of the small intestine impossible to reach till now. Balloon enteroscopy is much more reliable for seeing more distant parts of the small intestine than push enteroscopy. The case report of a 47-year-old female with hepatico-jejunoanastomosis (HJA) stenosis on Roux-en-Y loop is demonstrated. The HJA occurred after iatrogenic injury of the common hepatic duct. The patient suffered from repeated cholangitis for several months after surgery due to stenosis of the HJA. Magnetic resonance imaging cholangiography was first done to ascertain the conditions after the operation. Single balloon enteroscopy was performed to identify and resolve the stenosis. By using sedation we checked both arms of the entero-anastomosis and successfully identified the 2 mm wide orifice of the HJA. In the first session, dilatation of the stenosis using a dilator and balloon was performed and drainage was installed. During the second session we continued dilatation and drainage. In the third session we extracted the drainage and dilated by balloon the orifice of the HJA up to 10 mm. Since the first dilatation performed 15 months ago cholangitis has not occurred yet. Balloon enteroscopy is able to extend the spectrum of therapeutic methods of pancreatobiliary endoscopy in cases which so far have been the domain of radiologists and surgeons.

Key words:
balloon dilation – single balloon enteroscopy – ERCP – hepatico-jejunoanastomosis – cholangiography – stenosis – Roux-en-Y loop

Zdroje

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