A CASE OF EFFECTIVE ENDOSCOPIC TREATMENT USING A DIATHERMIC SHEATH FOR ANASTOMOTIC STRICTURE FORMATION AFTER SUBTOTAL STOMACH-PRESERVING PANCREATICODUODENECTOMY

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  • 胆管空腸吻合部狭窄に通電ダイレーターが有用であった1例

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The patient was a 78-year-old man who had undergone subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) for intraductal papillary mucinous carcinoma (IPMC). Four months after surgery, enzyme levels of the hepatobiliary system were elevated, and abdominal ultrasonography showed biliary sludge and expansion of peripheral bile ducts. Since an anastomotic stricture was suspected based on the diagnostic imaging, we performed endoscopic retrograde cholangiography (ERC) using a single-balloon endoscope. With this approach, severe stricture of the biliary-enteric anastomosis was visualized. Although a 0.025-inch guide wire could pass through the anastomotic stricture, it was not possible to pass a biliary balloon dilation catheter through the stricture. Therefore, we decided to incise the anastomotic stricture using a 6-Fr diathermic sheath (Cysto-Gastro-Set, Germany), which was advanced over the guide wire. An incision was made in the anastomotic stricture using an electrosurgical generator. Then, we performed balloon dilatation and completed the treatment. The patient experienced no serious complications with this procedure.<BR>We suggest that dilatation treatment using a diathermic sheath is a useful option for the management of biliary-enteric anastomotic stricture formation after surgery.

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