Per-oral cholangioscopy via a gastric access loop for the management of recurrent hepatolithiasis

Abstract

This is a case report of the successful management of recurrent large intrahepatic stones using per-oral cholangioscopy via a gastric access loop created surgically during Roux-en-Y hepaticojejunostomy (HJ). A 55-year-old male presented with acute cholangitis. Radiodiagnostic imaging suggested hepatolithiasis in the left hepatic duct. He had experienced similar events on three occasions in the past, for which preliminary conventional endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage approaches proved only supportive. Hence definitive surgical treatment was performed with the patient's consent during his third admission in the form of cholecystectomy, intraoperative retrieval of hepatolithiasis using a rigid ureteroscope, and Roux-en-Y HJ with gastric access loop formation. The gastric conduit facilitated prompt and convenient endoscopic access to enter the intrahepatic ducts and achieve complete ductal clearance using cholangioscopy-guided laser lithotripsy of the large intrahepatic stones. The patient remained asymptomatic at subsequent follow-up visits.

Keywords

• anastomosis
• roux-en-y; calculi; cholangitis; jaundice; lasers