ERCP with ballon dilation of the papilla and subsequent cholangioscopy with electro-hydraulic lithotripsy of the bile duct stone
Live endoscopy from the HSK Dr. Horst Schmidt Hospitals in Wiesbaden in collaboration with „Video Journal and Encyclopedia of GI Endoscopy“. Recording in the context of the Falk Symposium 185 „Interfaces and Controversies in Gastroenterology“ on October 3rd – 4th, 2012.
©2013 Elsevier. All rights reserved. Wirth the friendly assistance of Falk Foundation e.V., Freiburg.
Jürgen Pohl, HSK Dr. Horst-Schmidt-Kliniken Wiesbaden, Germany;
Chris Mulder, Vrieje Universiteit Amsterdam, The Netherlands
This is the case of a 69-year-old woman with jaundice and intermittent abdominal pain. ERCP in this patient showed an impacted bile duct stone that could not be retrieved. An attempt to capture the stone with a lithotripsy basket also failed.
In a next step, ERCP with balloon dilation of the papilla is performed to obtain adequate access for direct cholangioscopy and subsequent electrohydraulic lithotripsy of the stone.
Take home messages:
- Direct cholangioscopy is an easy and attractive technique for evaluation and treatment of pathologies in the common bile duct. It is also very useful for electrohydraulic lithotripsy of bile duct stones under direct visualization.
- To reduce the potential risk of common bile duct injury there are a few important advices:The first is: Always keep intraductal gas insufflation at an absolute minimum.
Moreover, it is strongly advised to perform a decent sphincterotomy that might be combined with balloon dilation up to 10 mm prior to cholangioscopy.
This allows adequate efflux of the gas and might prevent a ventile effect with subsequent gas embolization.
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