Year 2025 / Volume 117 / Number 8
Letter
Single-operator cholangioscopy unveiling a pinehole post-cholecystectomy biliary strictures

470-471

DOI: 10.17235/reed.2024.10551/2024

Luís Correia Gomes, Marta Moreira, Isabel Tarrio, Alda João Andrade, Tarcísio Araújo, Jorge Canena, Luís Lopes,

Abstract
77-year-old female with history of cholecystectomy was admitted at emergency department with fever and myalgia, without other complaints. Physical examination revealed fever, and laboratory tests indicated cholestasis (total bilirubin: 1.5xULN, glutamyltransferase: 20xULN, alkaline phosphatase: 5xULN). Computed Tomography revealed common bile duct (CBD) dilation (9mm), with suspected choledocholithiasis. Given the diagnosis of acute cholangitis, antibiotics were started and ERCP was performed. ERCP revealed a short CBD stenosis (< 2mm length), close to surgical clip, with upstream dilation of the CBD; an 8mm stone in the distal CBD was observed and successfully removed. As guidewire advancement failed after multiple attempts, a SpyGlass DS cholangioscopy was performed showing a fibrotic pinehole stenosis. Guidewire was passed through the stenosis under direct visualization, and an 80-mmx10mm fully covered metal stent deployed.
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References
1 - Parsa N, Khashab MA. The Role of Peroral Cholangioscopy in Evaluating Indeterminate Biliary Strictures. Clin Endosc. 2019 Nov;52(6):556-564. doi: 10.5946/ce.2019.011. Epub 2019 Jul 16. PMID: 31309767; PMCID: PMC6900308.
2- Navarrete C, Gobelet JM. Treatment of common bile duct injuries after surgery. Gastrointest Endosc Clin N Am. 2012 Jul;22(3):539-53. doi: 10.1016/j.giec.2012.04.023. PMID: 22748247.
3- Canena J, Liberato M, Coutinho AP, Marques I, Romão C, Veiga PM, Neves BC. Predictive value of cholangioscopy after endoscopic management of early postcholecystectomy bile duct strictures with an increasing number of plastic stents: a prospective study (with videos). Gastrointest Endosc. 2014 Feb;79(2):279-88. doi: 10.1016/j.gie.2013.07.022. Epub 2013 Sep 5. PMID: 24012251.
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Citation tools
Correia Gomes L, Moreira M, Tarrio I, Andrade A, Araújo T, Canena J, et all. Single-operator cholangioscopy unveiling a pinehole post-cholecystectomy biliary strictures. 10551/2024


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Publication history

Received: 19/05/2024

Accepted: 21/05/2024

Online First: 22/05/2024

Published: 24/07/2025

Article Online First time: 3 days

Article editing time: 431 days


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