Swetha (name changed), a 58-year-old woman, was presented to Sakra World Hospital with complaints of epigastric pain, 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 the intestine) which was causing all her gastrointestinal issues like vomiting and pain abdomen. It was also observed that the patient had an existing metal stent in the bile duct and an abnormal dense growth at the lower end of the stent.
On analyzing the patient’s medical history, doctors discovered that Swetha had been previously treated for Metastatic Distal End Cholangiocarcinoma in 2020. Furthermore, she has undergone Endoscopic Retrograde 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 the liver into the intestine, with a combination of X-ray and endoscopy). Swetha underwent the procedure twice, as the stent was blocked. Further, the cancer cells were infiltrating the first part of the intestine and securing the conduit between the stomach and intestine.
Observing the complexities, Dr. Amruthesh T.M, Dr. Lorance Peter, Director of Gastroenterology & Hepatology, Sakra World Hospital, and their team of Gastrointestinal specialists decided to resolve the situation through a 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 the 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, 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 improve nutrition through the oral route and continues her chemotherapy to control the bile duct cancer. I congratulate my entire team who made this impossible feat achievable.”
After her successful surgery in Sakra, while thanking the doctors, Swetha said, “I would like to extend my heartfelt gratitude to Dr. Amruthesh and the entire team of Sakra World Hospital for helping me recover from this fatal condition. With the complexities of my condition, my hopes started reducing. Dr. Amruthesh helped me understand my situation by elaborating on the condition and the procedure that was conducted, which eventually helped me gain confidence and hopes.”
