Die Praxisempfehlung der DDG "Diabetische Neuropathie" entstand in enger Anlehnung an die Nationale VersorgungsLeitlinie Neuropathie bei Diabetes im Erwachsenenalter, Langfassung, Version 1.2, 28. November 2011, basierend auf der Fassung von August 2011:
Background and Aims: EUS-guided choledochoduodenostomy (EUS-CDS) has become an established alternative to percutaneous or surgical approaches in cases of failed or predicted difficult ERCP. Methods: We report a case of complex endoscopic management of biliary obstruction in a 46-year-old woman with inoperable pancreatic adenocarcinoma. Because of tumor-related deformation of the papillary region, primary transpapillary drainage was not feasible. Results: EUS-CDS using a 6- × 8-mm electrocautery-enhanced lumen-apposing metal stent (LAMS) (Hot AXIOS stent; Boston Scientific, Marlborough, Mass, USA) was performed. Misdeployment of the distal flange led to bile leakage and stent dysfunction. Subsequent placement of a fully covered self-expandable metal stent (8 mm × 6 cm) (BONASTENT; MTW, Wesel, Germany) resulted in secondary stent dislocation into the paraduodenal space. The dislocated stent was successfully retrieved endoscopically through the original access using a 3-mm cholangioscope (Scivita, Boston Scientific). The duodenal defect was closed with 2 closure clips (MANTIS Clip, Boston Scientific). The patient recovered uneventfully and remained asymptomatic at 2-month follow-up. Conclusions: This case illustrates the feasibility of endoscopic rescue in a challenging scenario after LAMS misdeployment using advanced ERCP and closure techniques.
