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Temporizing Hepaticogastrostomy (EUS-HGS) to Reconnect a Strasberg E3 Bile Duct Injury (BDI) via Retrograde Cholangioperitoneoscopy Rendezvous (RCR)
Poster Abstract

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.

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