LAUSR

Variations of the biliary opening into the enteral lumen may cause conditions such as biliary colic, recurrent cholangitis, and pneumobilia, among others [1, 2]. Surgery is the main treatment, but it has high morbidity and mortality rates. Magnetic compression anastomosis (MCA) is a novel technique that has been widely applied in the gastrointestinal system [3]. Herein, we present a patient with an anomalous biliary opening that was treated withmagnet-assisted endoscopic choledochoduodenostomy (MECD), which was based on the MCA technique. A 36-year-old man with a history of biliary sepsis was referred to our clinic with the need for recurrent endoscopic retrograde cholangiopancreatography (ERCP) procedures. Previous ERCP examinations had demonstrated an anomalous opening of the common bile duct (CBD) into the duodenal bulb, which led to a hookshaped narrowing of the distal CBD (▶Fig. 1). Previous interventions using ERCP had been difficult to perform owing to apical bulb narrowing and had remained inconclusive. It was decided to performMECD (▶Fig. 2; ▶Video 1) to avoid the possible complications of bilioenteric diversion surgery. A 3.5 ×10-mm N35 Neodymium magnet was inserted into the distally narrowed CBD using the through-the-scope technique. Subsequently, a 10×10-mm N35 Neodymium magnet was inserted into the duodenal bulb endoscopically with the help of a snare. Fluoroscopy confirmed the alignment of the magnets (▶Fig. 3 a). After 20 days, the magnets were seen to be coupled on fluoroscopy (▶Fig. 3b) and they were removed endoscopically (▶Fig. 4). Cannulation and radiocontrast examination of this newly formed choledochoduodenal fistula demonstrated a well-formed tract from the biliary system through to the duodenum. A coated metal stent was inserted to preserve and enlarge the new opening. In conclusion, avoidance of the hookshaped distal narrowing and maintenance of a free passage for bile with the MECD technique protected the patient from future attacks stemming from biliary stasis, as well as from the complicaE-Videos