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Paraskevas Gkolfakis,Marc-André Bureau,Marianna Arvanitakis,Jacques Devière,Daniel Blero 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.1
A 44-year-old woman underwent sleeve gastrectomy, which was complicated by a leak. She was treated with two sessions ofendoscopic internal drainage using plastic double-pigtail stents. Her clinical evolution was favorable, but four months after the initialstent placement, she became symptomatic, and a gastrobronchial fistula with the proximal end of the stents invading the diaphragmwas diagnosed. She was treated with antibiotics, plastic stents were removed, and a partially covered metallic esophageal stent wasplaced. Eleven weeks later, the esophageal stent was removed with no evidence of fistula. Inappropriate stent size, position, stentingduration, and persistence of low-grade inflammation could explain the patient’s symptoms and provide a mechanism for gradualmuscle rupture and fistula formation. Although endoscopic internal drainage is usually safe and effective for the management ofpost-laparoscopic sleeve gastrectomy leaks, close clinical and radiological follow-up is mandatory.
Rawad A. Yared,Paraskevas Gkolfakis,Arnaud Lemmers,Vincent Huberty,Thierry Degrez,Jacques Devière,Daniel Blero 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.4
Portobiliary fistulas are rare but may lead to life-threatening complications. Biliary plastic stent-induced portobiliary fistulas during endoscopic retrograde cholangiopancreatography have been described. Herein, we present a case of portal cavernography and recurrent hemobilia after endoscopic retrograde cholangiopancreatography in which a portobiliary fistula was detected in a patient with portal biliopathy. This likely indicates a change in clinical presentation (from bilhemia to hemobilia) after biliary drainage that was successfully treated by placement of a fully covered, self-expandable metallic stent.