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Create a Free AccountProcedures - Stent placement
Over-the-wire snare-assisted stent exchange in endoscopic retrograde cholangiopancreatography
ERCP is an important therapeutic tool to address pancreatobiliary pathology. At times, negotiating a stricture with a wire can be challenging, but the nature of these lesions often mandates the placement of a temporary stent and often requires the exchange or upsize of stents to adequately manage the stricture. In such cases, it is efficient to preserve the tract established by the stent in the index procedure rather than renegotiating the stricture upon exchange. Toward this end, we demonstrate the steps of a method that allows preservation of the tract by removing the stent over a wire left in adequate position with the tip situated proximal (upstream) to the stricture.Endoscopic techniques and common pitfalls for nasobiliary catheter placement to facilitate delivery of high-dose intraductal brachytherapy in cholangiocarcinoma
Liver transplantation has been increasingly offered as a curative treatment option to a highly selected group of patients with unresectable perihilar cholangiocarcinoma.1 Patients who meet the transplant criteria at our institution undergo a protocolized therapy with neoadjuvant chemoradiation and brachytherapy followed by liver transplantation, with a 5-year disease-free survival rate of 55% to 65%.2Start of a new TREnD: TransRemnant Endoscopic Drainage for management of walled-off necrosis in a patient with Roux-en-Y gastric bypass
A 64-year-old woman with a history of Roux-en-Y gastric bypass (RYGB) was admitted to an outside hospital with severe necrotizing pancreatitis. Three weeks after her initial presentation, the patient was transferred to our hospital because of persistent abdominal pain and nausea, along with fever and worsening leukocytosis.ERCP-directed electrohydraulic lithotripsy for treatment of cystic duct and remnant gallbladder stones
A 55-year-old woman presented to the emergency department with postprandial right upper quadrant pain. An abdominal US demonstrated the presence of multiple hyperechoic, shadowing defects within the gallbladder along with gallbladder wall thickening (Fig. 1). These findings were consistent with acute calculous cholecystitis. The patient was then prepped for laparoscopic cholecystectomy.Reusing an electrocautery-enhanced stent deployment catheter to place additional pigtail stents for walled-off necrosis with disconnected duct
The development of an electrocautery-enhanced delivery system for lumen-apposing metal stents (Axios; Boston Scientific, Natick, Mass, USA) has simplified creation of a cystgastrostomy tract for the management of pancreatic walled-off necrosis. These larger-caliber transgastric metal stents are beneficial in terms of allowing for digestion and lavage of necrotic debris and to permit direct endoscopic necrosectomy.1,2 When disruption of the pancreatic duct is suspected, there remains a question of how to best manage the collection because there is a risk of recurrence of the collection, as well as highly morbid percutaneous fistulization if percutaneous drainage is attempted.
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