ReviewWorld journal of gastroenterology2026
Endoscopic ultrasound-guided transhepatic antegrade stone removal for choledocholithiasis after pancreaticoduodenectomy: A case report and review of literature.
Review in World journal of gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe special choledocholithiasis (common hepatic duct stone) proximal to hepaticojejunostomy anastomosis following pancreaticoduodenectomy (PD) presents significant therapeutic challenges because of surgically altered anatomy, which precludes the use of conventional endoscopic retrograde cholangiopancreatography. Endoscopic ultrasound (EUS) offers a minimally invasive alternative for antegrade stone extraction. Here, we report a rare case of EUS-guided transhepatic antegrade stone removal (EUS-TASR) in a patient with choledocholithiasis occurring eleven years after PD. CASE SUMMARY: A 58-year-old male with a history of PD for a duodenal tumor eleven years prior presented with a three-month history of intermittent upper abdominal discomfort. Imaging revealed a nodular filling defect in the common hepatic duct and mild intrahepatic biliary dilatation, confirming choledocholithiasis. Given the altered anatomy, endoscopic retrograde cholangiopancreatography was deemed unfeasible; thus, EUS-TASR with endoscopic nasobiliary drainage was successfully performed. The endoscopic nasobiliary drainage tube was removed on postoperative day 7, and the patient was discharged in stable condition on postoperative day 8. At the ten-month follow-up, the patient remained asymptomatic without complications.
conclusionEUS-TASR is a viable, minimally invasive approach for managing choledocholithiasis in post-PD patients with altered anatomy where conventional endoscopic access is restricted.
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