Doctors perform endoscopic intestinal bypass on woman suffering from bile duct cancer

Bengaluru: A 58-year-old woman, Shalini (name changed), approached Sakra World Hospital with complaints of epigastric pain and chest burning for three weeks and vomiting for a week. On diagnosing the same, Dr Amruthesh T M, Senior Consultant,– Gastroenterology, Sakra World Hospital discovered that Swetha had Metastatic Distal Cholangiocarcinoma (a form of cancer in the bile ducts) causing gastric outlet obstruction (blocking the emptying of stomach food contents into intestine) which was causing all her gastrointestinal issues like vomiting and pain in abdomen. It was also observed that the patient had an existing metal stent in the bile duct in place along with an abnormal dense growth at the lower end of the stent. On analyzing the patient's medical history, doctors found out that Shalini had been previously treated for Metastatic Distal End Cholangiocarcinoma in 2020. Furthermore, she has undergone endoscopic retrograde.

Shalini underwent cholangiopancreatography (ERCP - a procedure to diagnose and treat problems in the bile duct and place stents in the bile duct to facilitate the bile flow from liver into intestine, with a combination of X-ray and endoscopy) twice, as the stent was blocked. Further the cancer cells were infiltrating the first part of the intestine and blocking the conduit between the stomach and intestine.

Observing the complexities, Dr Amruthesh, Dr Lorance Peter, Director of Gastroenterology and Hepatology, Sakra, and their team of gastro-intestinal specialists decided to resolve the situation through unique endoscopic technique.

After a detailed discussion with the patient and her relatives on her health condition, his team and he planned to facilitate her feeding through Endoscopic Gastrojejunostomy (a procedure that connects part of the stomach to the small intestine), which enables movement of contents directly to the small intestine without passing through the initial blocked part. With the help of Endoscopic Ultrasound (EUS) and Fluoroscopy, a type of X-Ray imaging technique that shows real-time video of the process; an AXIOS stent was placed through and Gastrojejunostomy was conducted.

Elaborating on the unique feat, Dr. Amruthesh T M said, "It gives me immense pleasure to be a part of this unique and challenging Endoscopic procedure. This procedure helps the patient to improve nutrition through the oral route and continue her chemotherapy to keep the bile duct cancer under control. I would like to congratulate my entire team who made this impossible feat achievable."

Post her successful surgery, while thanking the doctors, Shalini said, "I would like to extend my heartfelt gratitude to Dr Amruthesh and the entire team of Sakra World Hospital for helping me recover back from this catastrophic condition. With the complexities of my condition, my hopes started reducing. Dr. Amruthesh helped me understand my situation by elaborating the condition and the procedure that was conducted, which eventually helped my gain confidence and hopes."