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Journal of Gastroenterology and Digestive Diseases | Volume 3
May 25-26, 2018 | New York, USA
World Liver Conference 2018
M
agnetic compression anastomosis (MCA) has been
developed as a non-surgical alternative treatment for
biliary obstruction; however, the precise assessment of the
local condition is still difficult. Intraductal ultrasonography
(IDUS) provides real-time, high-quality, cross-sectional
images of the bile duct and periductal structures. A 70-year-
old woman who had undergone pancreaticoduodenectomy
for pancreatic head cancer suffered from obstructed
choledocho-jejunostomy with no recurrent findings.
Cholangiography using the percutaneous transhepatic
cholangiographic drainage (PTCD) and fluoroscopy revealed
complete obstruction of the upper common bile duct, and
the distance of the obstruction was 7 mm. IDUS showed
fibrous heterogenous hyperechoic appearance without
fluid collection, vessels or foreign bodies at the site of the
obstruction. We performed choledocho-jejunostomy using
the MCA technique. One magnet was inserted into the
obstruction of the hepatic side through the PTCD fistula.
Another was delivered endoscopically to the obstruction of
the jejunal side. The twomagnetswere immediately attracted
towards each other transmurally, and reanastomosis was
confirmed seven days after starting the compression.
The magnets were easily retrieved endoscopically. A 16-
Fr indwelling drainage tube was placed in the duodenum
through the PTCD. The internal tube removed 12 months
after reanastomosis, and no MCA-related complications have
been observed. In conclusion, MCA is a safe, effective, low-
invasive treatment for biliary obstruction, and IDUS is useful
for the pretreatment assessment of feasibility and safety.
Speaker Biography
Hideaki Kawabata is a Clinical Gastroenterologist to the core and now Director of the
Department of Kyoto Okamoto Memorial Hospital, Head of the Gastroenterological
Center and Chief of the Palliative Care Team at our hospital, as well as a Specialist
and Councilor in the Japanese Society of Gastroenterology and the Japan
Gastroenterological Endoscopy Society and a Specialist in the Japanese Society of
Internal Medicine and the Japanese Society of Gastrointestinal Cancer Screening.
e:
hkawabata@okamoto-hp.or.jpIntraductal ultrasonography as a local assessment before magnetic compression anastomosis for
obstructed Choledocho-jejunostomy
Hideaki Kawabata, Naonori Inoue, Yukino Kawakatsu, Yuji Okazaki, Misuzu Hitomi, Masatoshi Miyata, Yoshikazu Tanaka
and
Yoshihiro Shimizu
Kyoto Okamoto Memorial Hospital, Japan