PMC9852524_01
Initial findings. (A) Abdominal magnetic resonance imaging showed massive lymphomatous lesions filling the peritoneal cavity. (B) Magnetic resonance cholangiopancreatography revealed an external compressive stricture in the superior middle common bile duct and dilation of the intrahepatic and extrahepatic ducts. (C) Endoscopic retrograde cholangiopancreatography showed ductal descending-junction stenosis of the duodenal bulb caused by lymphoma infiltration.
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F1
Magnetic resonance imaging and computed tomography of the abdomen both revealed numerous filling lymphomatous lesions in the abdominal cavity (Figure 1A), and magnetic resonance cholangiopancreatography showed external pressure stenosis in the middle segment of the common bile duct, expansion of the intrahepatic bile duct, and beak-like expansion of the intrahepatic bile duct (Figure 1B). ERCP was performed, but failed because of the infiltration of lymphoma into the duodenal bulb, which resulted in narrowing of the descending junction (Figure 1C). So, EUS-guided transgastric anterograde common bile duct stenting was performed under general anesthesia (Figure 2, Supplementary Video S1).
Endoscopic ultrasonography-guided biliary drainage. (A) Linear-array ultrasonography showed numerous filling lymphomatous nodules in the abdominal cavity. (B,C) The left hepatic duct was located for puncture. (D,E) The guidewire was passed through the confluence of the left and right hepatic ducts, and then through the site of common bile duct stricture. (F,G) Radiography indicated that the stricture site at the upper common bile duct was 4 cm away from the hepatic portal. (H) A bare metal stent (8 cm x 10 mm) was placed transgastrically in the common bile duct in an antegrade manner. (I,J) Gastroscopy demonstrated that the stent was passed through and stretched exactly out of duodenal papilla. (K,L) The puncture point in the stomach was closed with a titanium clip.
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F2
So, EUS-guided transgastric anterograde common bile duct stenting was performed under general anesthesia (Figure 2, Supplementary Video S1).