Abstract Text
Severe post-Chole BDI needs surgery, but morbidity is high. A frail patient with Strasberg E3 BDI underwent segment-3 EUS-HGS. Following leak control, magnetic compression anastomosis was attempted via HGS. Opposing magnets failed to couple across a wide gap. Endoscopic repair was offered to avoid surgery/permanent HGS. Cystotome/balloon access via ERCP allowed nasobiliary drain (NBD) placement into the subhepatic space. The NBD was targeted with a cystotome via HGS under fluoroscopy, coiling a wire into the subhepatic, and stabilizing it by an ultrathin scope. Parallel ERCP with cholangioscopy allowed subhepatic access and guidewire retrieval. Following this RCR, 2 plastic stents were placed by ERCP across the BDI. Uneventful recovery; patient awaits healing of reconnected duct before definitive stent removal.