avhadvidya@gmail.com
Networker
PROCEDURE PERFORMED: Endoscopic retrograde cholangiography with
internalization of bile duct stents by rendezvous procedure.
PREPROCEDURE DIAGNOSES: Gallbladder malignancy with obstructive jaundice,
status post history of interventional radiology and percutaneous biliary stent
placement.
POSTPROCEDURE DIAGNOSES: A 10-French 7 cm straight plastic biliary stent
placement into the biliary system with removal of internal and external
percutaneous drain.
CONSENT: Procedure risks and benefits were reviewed thoroughly with the
patient, risks including but not limited to bleeding, perforation, side
effects of medication were all informed. The patient voiced understanding and
agreed to proceed. Additional risks inherent to ERCP that being mild,
moderate, severe pancreatitis that could lead to postprocedural pain,
prolonged hospitalization, intensive care unit stay, and/or death were
reviewed with the patient who voiced understanding and agreed to proceed.
DESCRIPTION OF PROCEDURE: The patient was maintained in the supine position
after intubation and sedation. A side-viewing duodenoscope was passed
carefully and easily under indirect visualization into the esophagus, past the
second portion of duodenum brought in the shortened position. The ampulla
was visualized. There was a pigtail stent, which is part of the internal and
external drain placed by interventional radiology externally. The drainage
bag to the external portion of this drain was removed and a 0.035 wire was
passed externally through the external portion of the drain, passed through
the tube itself and then appreciated endoscopically. This tip of the wire was
grasped with a snare and then brought out through the channel of the scope.
As we were pulling the wire through the internal and external drain, the wire
itself was constantly being exposed to alcohol to sterilize the wire. The
wire was then appreciated through the channel of the scope and the snare was
removed and a biliary balloon was backloaded over the wire and advanced
endoscopically into the biliary system. The external portion of the drain was
transected. The internal locking system was transected, releasing the loop
and then the drain itself was removed from the patient's system. The biliary
balloon was then advanced into the proximal portion of the biliary system.
Aspiration of bile was appreciated. The balloon was inflated and an occlusion
balloon was performed. No frank obstruction was appreciated. The
intrahepatics and extrahepatic biliary system was not obstructed. Due to the
history of marked obstruction, the wire was maintained and the biliary balloon
was exchanged for a deployment device that advanced a 10-French 7 cm straight
plastic biliary stent that allowed for complete decompression of the biliary
system. Endoscopic and fluoroscopic images were obtained. The stomach was
suctioned, desufflated, and the scope was removed.
COMPLICATIONS: None.
BLOOD LOSS: None.
SPECIMENS: None.
RECOMMENDATIONS: Successful internalization of drain. The patient is due for
a CT scan in the next few weeks to follow up response to chemotherapy.
Repeat stent placement will be either a plastic versus metal pending her
response to treatment. The above was reviewed thoroughly with the patient who
voiced understanding and agreed to proceed.
internalization of bile duct stents by rendezvous procedure.
PREPROCEDURE DIAGNOSES: Gallbladder malignancy with obstructive jaundice,
status post history of interventional radiology and percutaneous biliary stent
placement.
POSTPROCEDURE DIAGNOSES: A 10-French 7 cm straight plastic biliary stent
placement into the biliary system with removal of internal and external
percutaneous drain.
CONSENT: Procedure risks and benefits were reviewed thoroughly with the
patient, risks including but not limited to bleeding, perforation, side
effects of medication were all informed. The patient voiced understanding and
agreed to proceed. Additional risks inherent to ERCP that being mild,
moderate, severe pancreatitis that could lead to postprocedural pain,
prolonged hospitalization, intensive care unit stay, and/or death were
reviewed with the patient who voiced understanding and agreed to proceed.
DESCRIPTION OF PROCEDURE: The patient was maintained in the supine position
after intubation and sedation. A side-viewing duodenoscope was passed
carefully and easily under indirect visualization into the esophagus, past the
second portion of duodenum brought in the shortened position. The ampulla
was visualized. There was a pigtail stent, which is part of the internal and
external drain placed by interventional radiology externally. The drainage
bag to the external portion of this drain was removed and a 0.035 wire was
passed externally through the external portion of the drain, passed through
the tube itself and then appreciated endoscopically. This tip of the wire was
grasped with a snare and then brought out through the channel of the scope.
As we were pulling the wire through the internal and external drain, the wire
itself was constantly being exposed to alcohol to sterilize the wire. The
wire was then appreciated through the channel of the scope and the snare was
removed and a biliary balloon was backloaded over the wire and advanced
endoscopically into the biliary system. The external portion of the drain was
transected. The internal locking system was transected, releasing the loop
and then the drain itself was removed from the patient's system. The biliary
balloon was then advanced into the proximal portion of the biliary system.
Aspiration of bile was appreciated. The balloon was inflated and an occlusion
balloon was performed. No frank obstruction was appreciated. The
intrahepatics and extrahepatic biliary system was not obstructed. Due to the
history of marked obstruction, the wire was maintained and the biliary balloon
was exchanged for a deployment device that advanced a 10-French 7 cm straight
plastic biliary stent that allowed for complete decompression of the biliary
system. Endoscopic and fluoroscopic images were obtained. The stomach was
suctioned, desufflated, and the scope was removed.
COMPLICATIONS: None.
BLOOD LOSS: None.
SPECIMENS: None.
RECOMMENDATIONS: Successful internalization of drain. The patient is due for
a CT scan in the next few weeks to follow up response to chemotherapy.
Repeat stent placement will be either a plastic versus metal pending her
response to treatment. The above was reviewed thoroughly with the patient who
voiced understanding and agreed to proceed.
