Work

A Stomach-Positioned Splinting Tube Technique for Maintaining a Straightened Gastric Axis During Endoscopic Retrograde Cholangiopancreatography in Severe Esophageal Hiatal Hernia

Year: 2026

Type: article

Abstract: Severe esophageal hiatal hernia can hinder endoscopic retrograde cholangiopancreatography (ERCP) by causing gastric looping and unstable duodenoscope advancement. We report a 76-year-old woman with gallbladder cancer, hilar biliary obstruction, and severe mixed-type hiatal hernia. Initial ERCP failed because recurrent looping prevented passage beyond the pylorus. During repeat ERCP, a hydrophilic splinting tube was not anchored in the duodenum but was positioned in the prepyloric stomach to maintain gastric axis reduction, defined as straightening of the looped intrathoracic stomach. This prevented recurrent looping, enabled stable duodenoscope advancement, and allowed transpapillary metal-stent placement, potentially reducing mucosal injury or perforation risk by avoiding duodenal bulb manipulation.

Source: ACG Case Reports Journal

DOI: 10.14309/crj.0000000000002200

Authors: Tsuyoshi Ueda, Koichiro Miyagawa, Shinji Oe, Risa Yoshitake, Reira Fukumoto, Kenta Kajitani, Daiki Uchihara, Nobuhiko Shinohara, Yuichi Honma, Michihiko Shibata, Masaru Harada

Institution: University of Occupational and Environmental Health Japan

Language: English

Topic: Gallbladder and Bile Duct Disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7166149954

FWCI:

Cites: 8

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