PMC6612668_01
Extraluminal endoscopic PTC/ERC rendezvous with simultaneous SEMS placement for management of an iatrogenic BDI. Image 1a shows the PTBC in place prior to performing the rendezvous intervention. Image 1b demonstrates the initial cholangiogram at ERC (Step 1) as the endoscopist prepares to position and deploy the stone extraction basket in the subhepatic space (Step 2). In 1c the guidewire has been passed transhepatic through the PTBC access (Step 3) and caught using the stone retrieval basket (Step 4). Image 1d shows the fully covered SEMS not yet expanded in place, bridging the gap (Step 5). Image 1e shows the fully expanded stent with the transhepatic wire in place as a new PTBC is deployed (Step 6). Image 1f demonstrates the final result of the PTC/ERC rendezvous with right-sided PTBC internalized through a SEMS.. PTC - percutaneous transhepatic cholangiogram, ERC - endoscopic retrograde cholangiography, SEMS - self-expanding metal stent, BDI - bile duct injury, PTBC - percutaneous transhepatic biliary catheter.
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fig0005
After placement of a transhepatic drain an extraluminal rendezvous procedure was performed and a 10 x 80 mm SEMS placed, bridging the defect (Fig. 1).
PMC6612668_02
Extraluminal endoscopic PTC/ERC rendezvous with simultaneous SEMS placement for management of a non-iatrogenic BDI. Image 2a shows the ERC placed guidewire just before advancing the stone extraction basket into the subhepatic space (Step 2). Image 2b demonstrates the percutaneously placed guidewire caught in the stone extraction basket (Step 4). Image 2c illustrates a right sided cholangiogram performed prior to removal of the PTBC. Images 2d and 2e show deployment of the SEMS, bridging the gap (Step 5). Image 2f shows the final result of the PTC/ERC rendezvous with a right-sided PTBC internalized through the SEMS (Step 6).. PTC - percutaneous transhepatic cholangiography, ERC - endoscopic retrograde cholangiography, SEMS - self-expanding mental stent, BDI - bile duct injury, PTBC - percutaneous transhepatic biliary catheter.
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fig0010
At extraluminal PTC/ERC rendezvous a 10 x 80 mm fully covered SEMS was placed, bridging the defect (Fig. 2).