Korean J Gastroenterol.  2023 Oct;82(4):190-193. 10.4166/kjg.2023.078.

A Road Less Traveled: Endoscopic Retrograde Cholangiopancreatography in a Patient with Long-standing Achalasia and Sigmoid Esophagus

• Trabelsi NO
• Marchut K
• Campos SRU
• Maggio D
• Rakovich G

• KMID: 2547289
• DOI: http://doi.org/10.4166/kjg.2023.078

Abstract

Endoscopic retrograde cholangiopancreatography in a patient with achalasia and sigmoid esophagus poses a unique technical challenge, as one must safely guide the side viewing duodenoscope across a severely distorted distal esophagus and non-relaxing lower esophageal sphincter. In such patients, the use of an overtube is a simple solution that allows the safe passage of a duodenoscope and the removal of common bile duct stones.

Keyword

Chlangiopancreatography; endoscopic retrograde; Esophageal achalasia

Figure

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  Fig. 1 (A) Extreme dilatation of the esophagus in a 38-year-old female patient with long-standing achalasia. (B) Acute sigmoid angulation (arrow) is observed where the redundant esophagus lies on the diaphragm.

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  Fig. 2 A non-relaxing lower esophageal sphincter “grips” an overtube (arrow) as it is being advanced into the stomach of a 38-year-old female with achalasia and sigmoid esophagus. As the semi-rigid overtube advances and straightens within the esophagus, the gastroesophageal junction can be seen invaginating into the stomach.

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  Fig. 3 Once in position across a non-relaxing lower esophageal sphincter, an overtube (A) allows the safe passage of a duodenoscope for an endoscopic retrograde cholangiopancreatography (B, C). A retained common bile duct stone (arrow) is then removed using a stone-extraction balloon (arrowheads outline the ends of the balloon) (D).

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