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Create a Free AccountAnatomy - Hepatopancreatobiliary
Cholangiocarcinoma obscured by a large paraesophageal hernia causing traction compression of the common hepatic duct ultimately diagnosed with percutaneous cholangioscopy
A 75-year-old man presented to an outside hospital with a 1-month history of painless jaundice. Abdominal CT and magnetic resonance imaging with contrast showed severe intrahepatic biliary ductal dilation with an abrupt cutoff in the common bile duct at the entrance into a large type IV hiatal hernia that contained the entire stomach, proximal duodenum, and colon (Fig. 1). The proximal duodenum was being pulled into the hernia tightly, leading to compression of the common bile duct (Fig. 2). His lipase level was normal (65 U/L), and the pancreas appeared normal on cross-sectional imaging.Cholangioscopy in primary sclerosing cholangitis: a case series of benign features
Cholangioscopy is useful in establishing a visual diagnosis of cholangiocarcinoma (CCA), but this is harder to achieve in primary sclerosing cholangitis (PSC) because of the stricture-forming nature of the disease. Furthermore, it can be harder to differentiate malignant from benign features of the underlying inflammation. This case series demonstrates the varied features of nonmalignant inflammatory findings in PSC.Disposable digital percutaneous cholangioscope-aided retrieval of a plastic biliary stent after failed retrieval at ERCP
A 74-year-old man presented 2 years after a cholecystectomy with abnormal liver function tests (total bilirubin 5.4 mg/dL, alkaline phosphatase 207 units/mL, aspartate aminotransferase 391 units/mL, and alanine aminotransferase 395 units/mL), a high-grade hilar stricture, and a filing defect in the right intrahepatic duct on magnetic resonance imaging. ERCP showed a 1.3-cm stricture in the common hepatic duct (CHD). Cholangioscopy (Spyglass DS II Access & Delivery Catheter, Boston Scientific, Natick, Mass, USA) showed a surgical staple in the mucosa at the distal end of the CHD stricture.Cholangioscopy in primary sclerosing cholangitis: a case series of dominant strictures and cholangiocarcinoma
Prompt and accurate differentiation of benign and malignant strictures in primary sclerosing cholangitis (PSC) is crucial. ERCP with brush cytology, the most common modality to achieve this, is hindered by a low diagnostic yield. Cholangioscopy can overcome this limitation by establishing a visual diagnosis based on the characteristic morphologic features of cholangiocarcinoma (CCA) and can aid in targeted biopsies of suspicious lesions. However, its role in PSC remains unclear. This case series demonstrates the performance of the latest generation of single-operator cholangioscope for this indication.Digital pancreatoscopy with electrohydraulic lithotripsy to treat a pancreatic duct stone
Debilitating pain is the predominant symptom in chronic pancreatitis, especially alcoholic pancreatitis,1 possibly from obstructing stones that increase intraductal pressure.2 Pancreatic duct (PD) stones occur in up to 90% of patients with alcoholic chronic pancreatitis.3 Unlike common bile duct stones, extraction of PD stones is challenging. They are harder and spiculated, and passage of a guidewire or endoscope is difficult because of the angulation of the PD at the genu. ERCP with pancreatic sphincterotomy and balloon/basket extraction can extract up to 75% of stones <10 mm.
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