Clin Endosc.  2019 Mar;52(2):201-202. 10.5946/ce.2018.131.

A Novel Approach for Incisionless Stone Management: Transpapillary Lumen-Apposing Metal Stent for Duct Clearance and Cholangioscopy Access

• Zimmer V

• KMID: 2447680
• DOI: http://doi.org/10.5946/ce.2018.131

Abstract

No abstract available.

MeSH Terms

Stents*

Figure

• 

  Fig. 1. (A) Ex-vivo presentation of a 30×10-mm yoyo-type lumen-apposing metal stent (LAMS) (flange diameter 25 mm) with a more sloping saddle-to-flange angle in contrast to other LAMS types; however, this type is considered favorable for the present and other short-stricture applications (LAMS, Diabolo stent; Leufen Medical, Berlin, Germany). (B) Endoscopic visualization of the LAMS immediately after placement. Note insufficient stent expansion with a retained bile duct stone visible at the LAMS saddle. (C) Direct cholangioscopy images obtained using an ultra-slim upper endoscope (Fujinon EG-530NW; Fujifilm, Düsseldorf, Germany; outer diameter 5.9 mm) the following day at the level of the stent entry showing whitened papillary mucosa related to tissue tension owing to radial stent forces. (D) The proximal stent end tightly adapts to the lower bile duct contour, forming a funnel-shaped outlet for spontaneous stone passage. (E) Complete through-the-LAMS cholangioscopy up to the hilum excluded the possibility of remnant stone disease, such that the LAMS could be removed and extracted orally. (F) The papilla after reinsertion reveals an inconspicuous largely collapsed opening, without signs of hemorrhage and with visible ample spontaneous bile flow.

Reference

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