A 76-year-old woman diagnosed nine months before a gastric adenocarcinoma, treated surgically with a total gastrectomy with Roux-en-Y reconstruction, was admitted due to weight loss and jaundice secondary to gastric recurrence.
ERCP was not performed due to the anatomical changes that it presented after surgery.
Drainage by PSSC was performed by an expert endoscopist (ELAA), after obtaining informed consent.
The left intrahepatic bile duct (LIHD) was identified using a linear echoend (Pentax, FG32-UA, USA).
The end of the anastomosis was placed approximately 5 cm distal to the jejunal anastomosis.
LIHD was punctured with a 19 G needle (EUSN-19-T, Endoscopy, Winston-Salem, NC, USA).
Contrast dye was injected under fluoroscopic control, demonstrating biliary opacification.
A 0.035 inch guide was installed through the ultrasound guidance needle and advanced under fluoroscopic control.
A sphincterotomy (Boston Scientific La Watertown, USA) was removed over the guide and a microincision and dilation of the jejunal fistula was performed.
A partially covered 6 cm long and 1 cm diameter metallic self-expanding stent was inserted through the LIHD fistula, without any other dilatation procedure.
There were no complications related to the procedure, and hepatic-jejunostomy was effective in resolving jaundice.
The patient was followed until her death 137 days after the PSSC.
