DSpace at Tokyo Dental College

上川床, 俊彦

四ツ谷, 護

大和田, 碧

石束, 叡

笠原, 正貴

山本, 将仁

阿部, 伸一

関根, 秀志

クラウンブリッジ補綴学

薬理学

解剖学

№３：変形性顎関節症モデルマウスにおける下顎頭形態およびAsporin の初期変化

Katayama, T

Nakamura, K

Arahata, K

Takarabe, S

Ojiro, K

Kishikawa, H

Nishida, J

市病・消化器内科

Posted at the Institutional Resources for Unique Collection and Academic Archives at Tokyo Dental College,
Available from http://ir.tdc.ac.jp/
Title
Successful reintervention using dual-channel
endoscope for perforation by partially migrated
stent after endoscopic ultrasound-guided
hepaticogastrostomy
Author(s)
Alternative
Katayama, T; Nakamura, K; Arahata, K; Takarabe, S;
Ojiro, K; Kishikawa, H; Nishida, J
Journal Endoscopy, 55(S 01): E256-E257
URL http://hdl.handle.net/10130/6276
Right
© 2022. The Author(s). This is an open access
article published by Thieme under the terms of the
Creative Commons Attribution-NonDerivative-
NonCommercial License, permitting copying and
reproduction so long as the original work is given
appropriate credit. Contents may not be used for
commercial purposes, or adapted, remixed,
transformed or built
upon.(https://creativecommons.org/licenses/by-nc-
nd/4.0/)
Description
Successful reintervention using dual-channel endoscope
for perforation by partially migrated stent after endoscopic
ultrasound-guided hepaticogastrostomy
Endoscopic ultrasound-guided hepatico-
gastrostomy (EUS-HGS) is the standard
endoscopic procedure for biliary obstruc-
tions [1–2]. Although various complica-
tions such as migration, perforation, and
abdominal peritonitis have been report-
ed after EUS-HGS [3–5], the reinterven-
tionmethod for them has not been estab-
lished. Herein, we present a case of
successful reintervention for a migrated
stent after EUS-HGS using a dual-channel
endoscope and grasping forceps.
An 88-year-old man with pancreatic
cancer underwent EUS-HGS for malig-
nant biliary obstruction, and a partially
covered self-expandable metallic stent
(SEMS) was placed on the B3 branch. The
patient had a high fever 2 days after
EUS-HGS. Computed tomography (CT)
revealed free air in the abdominal cavity
(▶Fig. 1), which was caused by the shift-
ing of the uncovered part of the SEMS to
the gastric side by respiratory fluctua-
tion. A reintervention for additional stent
placement was urgently performed. A
dual-channel endoscope (GIF-2TQ260M;
Olympus, Tokyo, Japan) was inserted into
the EUS-HGS site. A guidewire was then
advanced through the EUS-HGS stent
into the right hepatic duct (▶Video 1).
However, the catheter could not advance
through the B3 branch due to its strong
bend. The EUS-HGS stent was too long,
poorly anchored, and was difficult to
align with the axis; therefore, it could not
transmit force in the direction of the
catheter (▶Fig. 2). Grasping forceps in-
serted from the other channel grasped
and pulled the stent (▶Fig. 3), after
which the catheter and stent delivery sys-
tem advanced through the bend of the B3
branch by counter-traction (▶Fig. 4). The
fully covered SEMS (Boston Scientific,
Marlborough, Massachusetts, USA) was
then deployed through the stent to the
proximal B3 branch (▶Fig. 5). After 1
week, CT showed the disappearance of
free air and the biliary metallic stent in
the appropriate position. Stent place-
ment using a dual-channel endoscope
and grasping forceps may be considered
a useful treatment for stent complica-
tions after EUS-HGS.
Endoscopy_UCTN_Code_CPL_1AL_2AD
Competing interests
The authors declare that they have no con-
flict of interest.
Video 1 As a reintervention for additional stent placement, a dual-channel endoscope
and grasping forceps were used. Pulling the endoscopic ultrasound-guided hepaticogas-
trostomy stent by grasping the forceps, catheter, and stent delivery system enabled pas-
sage through the bend of the B3 branch by counter-traction.
▶ Fig. 1 Computed tomography images. a No free air in the abdominal cavity immediately
after endoscopic ultrasound-guided hepaticojejunostomy (EUS-HGS). b The presence of free
air 2 days after EUS-HGS.
E-Videos
E256 Katayama Tadashi et al. Successful reintervention using… Endoscopy 2023; 55: E256–E257 | © 2022. The Author(s).
Article published online: 2022-11-25
The authors
Tadashi Katayama , Kenji Nakamura , Kyoko
Arahata, Sakiko Takarabe, Keisuke Ojiro,
Hiroshi Kishikawa, Jiro Nishida
Department of Gastroenterology, Tokyo Dental
College, Ichikawa General Hospital, Sugano,
Ichikawa, Chiba, Japan
Corresponding author
Kenji Nakamura, MD
Department of Gastroenterology, Tokyo
Dental College, Ichikawa General Hospital,
5-11-13, Sugano, Ichikawa, Chiba, Japan
Fax: +81-47-325-4456
kenakamura@tdc.ac.jp
References
[1] Wang K, Zhu J, Xing L et al. Assessment of
efficacy and safety of EUS-guided biliary
drainage: a systematic review. Gastrointest
Endosc 2016; 83: 1218–1227
[2] Nakai Y, Isayama H, Yamamoto N et al.
Safety and effectiveness of a long, partially
covered metal stent for endoscopic ultra-
sound-guided hepaticogastrostomy in pa-
tients with malignant biliary obstruction.
Endoscopy 2016; 48: 1125–1128
[3] Nakamura K, Kisikawa H, Katayama T et al.
Stent placement using dual-channel endo-
scope for biloma after EUS-guided hepa-
ticogastrostomy. J Hepatobiliary Pancreat
Sci 2021; 28: e45–e46
[4] Okamoto A, Minaga K, Takenaka M et al. A
novel technique for stent dysfunction after
endoscopic ultrasound-guided hepaticogas-
trostomy with antegrade stenting. Endos-
copy 2019; 51: E255–E256
[5] Yane K, Katanuma A, Maguchi H et al. Suc-
cessful re-intervention with metal stent
trimming using argon plasma coagulation
after endoscopic ultrasound-guided hepa-
ticogastrostomy. Endoscopy 2014; 46:
E391–E392
Bibliography
Endoscopy 2023; 55: E256–E257
DOI 10.1055/a-1968-7086
ISSN 0013-726X
published online 25.11.2022
© 2022. The Author(s).
This is an open access article published by Thieme under the
terms of the Creative Commons Attribution-NonDerivative-
NonCommercial License, permitting copying and reproduc-
tion so long as the original work is given appropriate credit.
Contents may not be used for commercial purposes, or
adapted, remixed, transformed or built upon. (https://
creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG, Rüdigerstraße 14,
70469 Stuttgart, Germany
▶ Fig. 2 Catheter could not advance through the strong bend of the B3 branch. a Fluoro-
scopic view. b Schema.
▶ Fig. 3 Endoscopic view showing the
stent grasped using grasping forceps
inserted from the other forceps channel
of the dual-channel endoscope.
▶ Fig. 4 Fluoroscopic view showing the
passage of the catheter by counter-trac-
tion through the strong bend of the B3
branch by pulling the grasped stent.
▶ Fig. 5 a Fluoroscopic view showing the deployment of the additional biliary metallic stent
beyond the bend of the B3 branch to the proximal site in a stent-in-stent manner. b Endo-
scopic view showing the additional biliary metallic stent.
Katayama Tadashi et al. Successful reintervention using… Endoscopy 2023; 55: E256–E257 | © 2022. The Author(s). E257


Successful reintervention using dual-channel endoscope for perforation by partially migrated stent after endoscopic ultrasound-guided hepaticogastrostomy

山口, 朗

1.「顎骨疾患プロジェクト」の総括と今後の展望

西井, 康

松林, 秀繁

松永, 智

戒田, 直紀

笠原, 正彰

笠原, 典夫

北村, 啓

立木, 千恵

山本, 楓華

【II.分子レベルによる口腔疾患の病因解明と新たな診断・治療法の開発】歯槽骨骨量・骨質コントロールによる歯の移動促進法の確立

今村, 健太郎

③リスク因子検討研究部門

Kuroda, S

Yotsuya, M

Sato, T

Hisanaga, R

Nomoto, S

Sekine, H

The effect of scanning pathways on trueness and precision in full-arch optical impression

Tokyo Dental College Guide Book 2023

Mochizuki, M

Hisamatsu, T

市病消化器内科

Posted at the Institutional Resources for Unique Collection and Academic Archives at Tokyo Dental College,
Available from http://ir.tdc.ac.jp/
Title
Electrohydraulic lithotripsy for ball valve
syndrome due to stent-stone complex after
endoscopic ultrasound-guided hepaticogastrostomy
Author(s)
Mochizuki, M; Nakamura, K; Arahata, K; Takarabe, S;
Kishikawa, H; Hisamatsu, T; Nishida, J
Journal Endoscopy, 55(S 01): E798-E799
URL http://hdl.handle.net/10130/6329
Right
This is an open access article published by Thieme
under the terms of the Creative Commons
Attribution-NonDerivative- NonCommercial License,
permitting copying and reproduction so long as the
original work is given appropriate credit. Contents
may not be used for commercial purposes, or
adapted, remixed, transformed or built upon.
(https://creativecommons.org/licenses/by-nc-
nd/4.0/)
Description
Electrohydraulic lithotripsy for ball valve syndrome due to stent-stone
complex after endoscopic ultrasound-guided hepaticogastrostomy
Endoscopic ultrasound-guided hepatico-
gastrostomy (EUS-HGS) is the standard
endoscopic procedure for malignant bili-
ary obstruction [1, 2]. However, the rate
of EUS-HGS-associated adverse events
remains high, and various severe compli-
cations, including risk factor and rescue
techniques, have been reported [3–5].
We present a rare case of electrohydraulic
lithotripsy (EHL) for ball valve syndrome
due to a stent-stone complex after EUS-
HGS.
An 88-year-old woman, who underwent
EUS-HGS for recurrent biliary obstruc-
tion caused by refractory transpapillary
drainage due to biliary cancer, presented
with acute-onset vomiting. Contrast-en-
hanced computed tomography revealed
a calculus that had formed at the end of
the stent on the gastric side. The stent
was pulled into the duodenum, with the
calculus visible as the leading part of the
stent (▶Fig. 1). On upper endoscopy, the
EUS-HGS stent was pulled into the
duodenum beyond the pyloric ring,
grasped, and pulled back into the stom-
ach (▶Video 1). A 5-cm stent-stone com-
plex was noted at the end of the EUS-HGS
stent (▶Fig. 2). Gastric ulceration due to
compression of the EUS-HGS stent was
observed (▶Fig. 3). Since grasping for-
ceps, an endoscopic snare, and argon
plasma coagulation (APC) failed to crush
the stent-stone complex, electrohydrau-
lic lithotripsy (EHL) with 1200 shots was
used. One-quarter of the complex was
crushed via EHL, and the stent was trim-
med with APC. However, the stent-stone
complex was still unable to pass through
the pharyngoesophageal junction. This
was additionally crushed using EHL with
3000 shots (▶Fig. 4). After crushing the
stent-stone complex, the trimmed stent
and the fragments were successfully re-
moved (▶Fig. 5).
There are no reports of ball valve syn-
drome caused by a stent-stone complex
formed on an EUS-HGS stent, which is a
rare complication of EUS-HGS. EUS-HGS
is a relatively new procedure that may
cause rare complications. Clinicians
Video 1 Electrohydraulic lithotripsy for ball valve syndrome due to a stent-stone com-
plex after endoscopic ultrasound-guided hepaticogastrostomy.
▶ Fig. 1 Contrast-enhanced computed tomography scans showing the calcified stent-stone
complex (white arrows) formed at the end of the stent on the stomach side and pulled into
the duodenum. a Axial view. b Coronal view.
▶ Fig. 2 Endoscopic view of the esopha-
gogastroduodenoscopy showing the
stent-stone complex (white arrow), just
after being pulled back into the stomach,
formed on an endoscopic ultrasound-
guided hepaticogastrostomy stent (red
arrowhead) pulled into the duodenum.
E-Videos
E798 Mochizuki Moegi et al. Electrohydraulic lithotripsy for… Endoscopy 2023; 55: E798–E799 | © 2023. The Author(s).
Article published online: 2023-06-15
should be aware of these complications
and be ready to manage them using mini-
mally invasive treatments.
Endoscopy_UCTN_Code_CCL_1AZ_2AD
Competing interests
The authors declare that they have no con-
flict of interest.
The authors
Moegi Mochizuki1, 2, Kenji Nakamura1 ,
Kyoko Arahata1, Sakiko Takarabe1, Hiroshi
Kishikawa1, Tadakazu Hisamatsu2 , Jiro
Nishida1
1 Department of Gastroenterology, Tokyo
Dental College, Ichikawa General Hospital,
Chiba, Japan
2 Department of Gastroenterology and
Hepatology, Kyorin University School of
Medicine, Tokyo, Japan
Corresponding author
Kenji Nakamura, MD
Department of Gastroenterology, Tokyo
Dental College, Ichikawa General Hospital,
5-11-13, Sugano, Ichikawa, 272-8513,
Chiba, Japan
Fax: +81-47-325-4456
kenakamura@tdc.ac.jp
References
[1] van der Merwe SW, van Wanrooij RLJ,
Bronswijk M et al. Therapeutic endoscopic
ultrasound: European Society of Gastro-
intestinal Endoscopy (ESGE) Guideline.
Endoscopy 2022; 54: 185–205
[2] Umonceau JM, Tringali A, Papanikolaou IS et
al. Endoscopic biliary stenting: indications,
choice of stents, and results: European So-
ciety of Gastrointestinal Endoscopy (ESGE)
Clinical Guideline – Updated October 2017.
Endoscopy 2018; 50: 910–930
[3] Ochiai K, Fujisawa T, Ishi S et al. Risk factor
for stent migration into the abdominal
cavity after endoscopic ultrasound-guided
hepaticogastrostomy. J Clin Med 2021; 10:
3111
[4] Nakamura K, Kishikawa H, Ojiro K et al. Stent
placement using dual-channel endoscope
for biloma after EUS-guided hepaticogas-
trostomy. J Hepatobiliary Pancreat Sci 2021;
28: e45–e46
[5] Katayama T, Nakamura K, Arahata K et al.
Successful reintervention using dual-chan-
nel endoscope for perforation by partially
migrated stent after endoscopic ultrasound-
guided hepaticogastrostomy. Endoscopy
2023; 55: E256–E257
Bibliography
Endoscopy 2023; 55: E798–E799
DOI 10.1055/a-2092-4224
ISSN 0013-726X
© 2023. The Author(s).
This is an open access article published by Thieme under the
terms of the Creative Commons Attribution License, permit-
ting unrestricted use, distribution, and reproduction so long
as the original work is properly cited.
(https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG, Rüdigerstraße 14,
70469 Stuttgart, Germany
▶ Fig. 3 The schema of the ball valve syndrome due to a stent-stone complex formed on the
endoscopic ultrasound-guided hepaticogastrostomy stent and pulled back from the duode-
num into the stomach using an upper endoscopy with a grasping forceps.
▶ Fig. 4 Endoscopic view of the esopha-
gogastroduodenoscopy showing the
longitudinal and deep gastric ulceration
(yellow arrowheads) due to compression
of endoscopic ultrasound-guided hepa-
ticogastrostomy stent (red arrowhead)
pulled into the duodenum.
▶ Fig. 5 Endoscopic view of the esopha-
gogastroduodenoscopy showing the
trimmed stent end of endoscopic ultra-
sound-guided hepaticogastrostomy and
crushed fragments of the stent-stone
complex.
Mochizuki Moegi et al. Electrohydraulic lithotripsy for… Endoscopy 2023; 55: E798–E799 | © 2023. The Author(s). E799


Electrohydraulic lithotripsy for ball valve syndrome due to stent-stone complex after endoscopic ultrasound-guided hepaticogastrostomy

一戸, 達也

東京歯科大学の戦略

Oki, T

Ohta, M

Takano, T

Sakurai, K

Ueda, T

老年歯科補綴学

Effective training duration and frequency for lip-seal training in older people using a self-training instrument

Tokyo Dental College

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