deidre76
New
need help with Endoscopic ultrasound with deployment of lumen opposing metal stent creating a choledochoduodenostomy
should I use a unlisted and compare with 43240 that is the closest I can find
or use 43259 and 43266
Initially, duodenoscope was advanced and with difficulty, and with the scope mostly in the long position, I was able to identify the papilla.
This was suckcked in, and fibrotic, inferior to this there was a diverticulum. There was friability of the papillary opening with attempted
impaction and passage of wire. After attempting for several minutes, I determined that this approach was likely to be unsuccessful.
Scope was exchanged for linear echoendoscope. This was advanced without difficulty and the head of the pancreas area was inspected.
Mass was readily identified but not inspected in detail. In keeping with the CT findings, there was dilation of the common bile duct and
pancreatic duct significantly. The common bile duct measured 23 mm in diameter. A window for deployment of lumen opposing metal
stent was felt to be possible and accessible with the scope in the flexed short position and the tip above the papilla. 8 x 8 mm lumen
opposing metal stent delivery system was advanced, and then using standard technique, the catheter with application of cautery was
passed without difficulty through the duodenal wall into the bile duct. Wire was advanced into the bile duct, and fluoroscopic confirmation
was obtained. Successful deployment of the stent then ensued with initial release of the inner bolster under sonographic guidance,
adjustment of the catheter, and deployment of the remainder of the stent so that the stent was visible in the duodenal wall. Flow of bile
was noted. However, initially, there was concern about some possible hemorrhage due to inadvertent use of the narrow band imaging
setting, and forward-viewing scope was subsequently advanced confirming no evidence of blood, free flow of bile was noted into the
duodenum.
should I use a unlisted and compare with 43240 that is the closest I can find
or use 43259 and 43266
Initially, duodenoscope was advanced and with difficulty, and with the scope mostly in the long position, I was able to identify the papilla.
This was suckcked in, and fibrotic, inferior to this there was a diverticulum. There was friability of the papillary opening with attempted
impaction and passage of wire. After attempting for several minutes, I determined that this approach was likely to be unsuccessful.
Scope was exchanged for linear echoendoscope. This was advanced without difficulty and the head of the pancreas area was inspected.
Mass was readily identified but not inspected in detail. In keeping with the CT findings, there was dilation of the common bile duct and
pancreatic duct significantly. The common bile duct measured 23 mm in diameter. A window for deployment of lumen opposing metal
stent was felt to be possible and accessible with the scope in the flexed short position and the tip above the papilla. 8 x 8 mm lumen
opposing metal stent delivery system was advanced, and then using standard technique, the catheter with application of cautery was
passed without difficulty through the duodenal wall into the bile duct. Wire was advanced into the bile duct, and fluoroscopic confirmation
was obtained. Successful deployment of the stent then ensued with initial release of the inner bolster under sonographic guidance,
adjustment of the catheter, and deployment of the remainder of the stent so that the stent was visible in the duodenal wall. Flow of bile
was noted. However, initially, there was concern about some possible hemorrhage due to inadvertent use of the narrow band imaging
setting, and forward-viewing scope was subsequently advanced confirming no evidence of blood, free flow of bile was noted into the
duodenum.