Basim Ali, MD, Tara Keihanian, MD, Wasif Abidi, MD, PhD Baylor College of Medicine, Houston, TX
Introduction: Single-use duodenoscopes decrease the risk of cross-contamination and can limit costs by eliminating the need for processing and repair. The "aScope Duodeno" by Ambu® is a fully disposable, single use duodenoscope, but experience in its use for complex endoscopic retrograde cholangiopancreatography (ERCP) is limited.
Case Description/Methods: A 32-year-old female with a history of a Roux-en-Y gastric bypass for obesity and cirrhosis secondary to alcohol use disorder, status-post liver transplant, presented with ascending cholangitis and choledocholithiasis. She was found to have bacteremia with Klebsiella species. Considering the acuity of her symptoms, a percutaneous transhepatic internal-external biliary drain was placed for biliary decompression.
To address the obstructive stones, a staged endoscopic ultrasound-guided transgastric ERCP (EDGE) procedure was performed. First, a lumen-apposing metal stent (LAMS) was placed to connect the gastric pouch and the bypassed stomach. Two weeks later, an ERCP was performed through the LAMS using a traditional, reusable duodenoscope. Despite successful stone extraction, the procedure was technically difficult due to pyloric stenosis requiring dilation with a balloon dilator, limited mobility of the endoscope due to the constraints of the altered anatomy, and difficulty with fluoroscopic visualization of the entire bile duct. Given persistent elevation in alkaline phosphatase and concern for a retained biliary stone, the patient underwent a repeat ERCP in three weeks. This time, the Ambu® single use duodenoscope was advanced through the LAMS to the level of ampulla. Due to the high flexibility of the scope and its light weight, the procedure was performed with technical ease. Balloon sweep of the CBD was unremarkable for residual stones or debris. As the distal portion of the insertion tube and the flexible portion of the Ambu® scope are transparent under fluoroscopy, a cholangiogram was obtained with minimal contrast and limited need to maneuver the scope. The LAMS was then removed, and the iatrogenic gastro-gastric fistula was closed with an endoscopic tacking system.
Discussion: Single use duodenoscope by Ambu® is a feasible device in patients with altered anatomy. The fluoroscopically transparent distal end of the scope is a unique feature of this device and beneficial in challenging positions with limited space for maneuverability.
Figure: The single use aScope Duodeno can provide advantages in endoscopic retrograde pancreatography with limitations in maneuverability, as shown in this procedure in a patient with a Roux-en-Y gastric bypass performed through a LAMS-based iatrogenic gastro-gastric fistula. (A) Traditional endoscope being used to extract stones (B) aScope Duodeno being used to fully clear the biliary ducts on follow-up ERCP with transparent distal end under fluoroscopy
Disclosures:
Basim Ali indicated no relevant financial relationships.
Tara Keihanian indicated no relevant financial relationships.
Wasif Abidi: Ambu USA – Consultant. Apollo Endosurgery – Consultant. ConMEd – Consultant. GI dynamics – Grant/Research Support.
Basim Ali, MD, Tara Keihanian, MD, Wasif Abidi, MD, PhD. B0483 - Feasibility of a New Generation Single Use Duodenoscope in a Patient With Roux-en-Y Gastric Bypass, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
