Abstract
A 78 years old female with h/o distal gastrectomy for gastric cancer with Billroth II and Whipple procedure for LN recurrence had multiple biliary stones. ERC using PCF failed because of complicated surgically altered anatomy. EUS-guided antegrade treatment (AG) was then performed. The biliary duct was accessed followed by balloon dilation of the anastomosis and stone removal into the intestine using a retrieval balloon. Two sessions of stone removal failed in complicate stone clearance. Temporal placement of fully covered metallic stent (CMS) at the fistula enabled complete stone clearance.
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