Intractable biliary obstruction after TIPS creation treated by magnet-assisted endoscopic biliary-duodenal anastomosis
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Intractable biliary obstruction after TIPS creation treated by magnet‑assisted endoscopic biliary‑duodenal anastomosis Linhao Zhang1,2 · Bo Wei1 · Hao Wu1 · Bing Hu1 Received: 4 May 2020 / Accepted: 27 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Though biliary obstruction is a common clinical situation, it is rarely caused by transjugular intrahepatic portosystemic shunt (TIPS) placement. When TIPS-induced intractable biliary obstruction happens, liver transplantation seems to be the only resort to cure this condition. Methods Herein, we describe a patient who suffered from intractable biliary obstruction following TIPS placement. Results The patient was finally cured by magnet-assisted endoscopic biliary-duodenal anastomosis, without further requirement of liver transplantation. After more than 6 months of follow-up, this patient recovered well, and recurrence of biliary obstruction was not observed. Conclusion We showed that magnet-assisted endoscopic biliary-duodenal anastomosis is a safe method, which is easy to perform and worthy of popularizing. Keywords Biliary-duodenal anastomosis · Biliary obstruction · Magnet · Endoscopy · Transjugular intrahepatic portosystemic shunt Abbreviations CT Computed tomography; CTPV Cavernous transformation of portal vein; PTCD Percutaneous transhepatic cholangial drainage TIPS Transjugular intrahepatic portosystemic shunt
Linhao Zhang and Bo Wei have contributed equally to this study. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07963-0) contains supplementary material, which is available to authorized users. * Hao Wu [email protected] * Bing Hu [email protected] 1
Department of Gastroenterology, West China Hospital, Sichuan University, Guo Xue Lane 37#, Chengdu 610041, Sichuan, People’s Republic of China
Laboratory of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Guo Xue Lane 37#, Chengdu 610041, Sichuan, People’s Republic of China
2
Biliary obstruction is a common clinical problem, which could be caused by cholelithiasis, and pancreatic and biliary tumors. Rarely, it could also be induced by anatomic abnormality [1], infection [2], lymphadenitis [3], and even transjugular intrahepatic portosystemic shunt (TIPS) placement. To date, biliary obstruction because of TIPS was reported in 6 case reports, and in some patients, liver transplantation was necessitated when TIPS-induced biliary obstruction could not be relieved spontaneously [4–9]. Herein, we describe a patient who suffered from intractable biliary obstruction following TIPS placement. He was treated by magnet-assisted endoscopic biliary-duodenal anastomosis, without further requirement of liver transplantation.
Case report A 19-year-old Chinese male came to our hospital complaining of repeated hematochezia for 18 years. On admission, his hemoglobin was 40 g/L (reference range: 120 to 160 g/L), wit
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