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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.Step-by-step use of hemostatic powder: treatment of a bleeding GI stromal tumor
Hemostatic powder (Hemospray; Cook Medical, Winston-Salem, NC, USA) was recently granted clearance for clinical use by the U.S. Food and Drug Administration for endoscopic therapy of nonvariceal GI hemorrhage (Fig. 1). This device has been in use internationally for more than 5 years, since it became available in 2011, and has been used in more than 70,000 procedures.1 The powder is an inert, nontoxic material called bentonite, and it is aerosolized with the use of a carbon dioxide canister to deliver the powder through a 7F or 10F delivery catheter.
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