Common bile duct

Surgery

Covered stent

Balloon

Esophageal stricture

Balloon dilatation

Biliary stent

Radiology

Stent

Bile duct

Esophagus

Medicine

General surgery

Gastrointestinal Endoscopy

A 73-year-old man with a history of cerebral palsy and anoxic brain injury who received nutrition through a PEG tube presented for management of choledocholithiasis. ERCP was attempted; however, a severe benign esophageal stricture (A) 2 mm in diameter was encountered in the distal part of the esophagus that did not allow for passage of the duodenoscope. Through-the-scope (TTS) balloon dilatation was performed up to 10 mm. Five days later, TTS balloon dilatation was performed up to 12 mm. A 23 mm × 125 mm fully covered esophageal stent was then placed across the stricture (B) and anchored in place with 2 endoscopically placed sutures. A duodenoscope was then inserted but could not traverse the waist of the stent; thus, TTS balloon dilatation was performed up to 15 mm. The duodenoscope was then passed through the stent, and the common bile duct was cannulated. A cholangiogram revealed an 8-mm distal common bile duct stone (C). Stone extraction was successfully performed by use of a sphincterotomy and balloon sweep (D). There were no adverse events, and the patient was discharged the same day with plans for stent removal 3 weeks after the procedure. We believe that this is the first described case of esophageal stent-assisted biliary access in the setting of an esophageal stricture.

Esophageal stent–assisted biliary access