Intractable biliary obstruction after TIPS creation treated by magnet-assisted endoscopic biliary-duodenal anastomosis

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.

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Fig. 1

Abbreviations

CT:

Computed tomography;

CTPV:

Cavernous transformation of portal vein;

PTCD:

Percutaneous transhepatic cholangial drainage

TIPS:

Transjugular intrahepatic portosystemic shunt

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Acknowledgements

This study was supported by 1·3·5 project for disciplines of excellence—Clinical Research Incubation Project, West China Hospital, Sichuan University (Grant No. 2019HXFH024); Science and Technology Department of Sichuan Province (2020YJ0083); China Postdoctoral Science Foundation Grant (Grant No. 2019M653436); Post-Doctor Research Project, West China Hospital, Sichuan University (Grant No. 2019HXBH013). The authors thank Dr. Liansong Ye (Department of Gastroenterology, West China Hospital, Sichuan University) for his kind help.

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Correspondence to Hao Wu or Bing Hu.

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Disclosures

Drs. Linhao Zhang, Bo Wei, Hao Wu, and Bing Hu have no conflict of interest or financial ties to disclose.

Ethical approval

This study conformed to the principles of Declaration of Helsinki for medical research and ethical approval was not needed for this case report from institutional review board of West China Hospital according to its policy.

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Written informed consent for patient information and images to be published was provided by the patient.

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Choledochoscope was introduced via PTCD fistula after removal of 20fr tube to advance an 8 mm magnet into biliary duct. After identification of the narrowing of bile duct and a site of duodenal wall, where was closest to the narrowing, a 10 mm string-attached magnet was placed to the site by endoscope. Finally, the magnets were allowed to align together during endoscopy. Supplementary file1 (AVI 78454 kb)

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Zhang, L., Wei, B., Wu, H. et al. Intractable biliary obstruction after TIPS creation treated by magnet-assisted endoscopic biliary-duodenal anastomosis. Surg Endosc 35, 467–470 (2021). https://doi.org/10.1007/s00464-020-07963-0

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Keywords

  • Biliary-duodenal anastomosis
  • Biliary obstruction
  • Magnet
  • Endoscopy
  • Transjugular intrahepatic portosystemic shunt