I am a gastroenterologist. This is a blog of the ERCPs and related endoscopic procedures carried out at my department. Dr Adnan Salim.
Sunday, July 3, 2016
Second (actually 3rd) ERCP for post transplant biliary leak
This 60 year old gentleman had earlier undergone ERCP and stenting for an anastomotic biliary leakage a few months earlier http://ercp365.blogspot.com/2015/09/first-ercp-for-post-transplant.html?m=1. A 7 French 12 cm plastic stent was placed across the site of leakage and later removed. His bilirubin levels had showed a mild rise over the past few months and ultrasound showed a small collection in the subhepatic space (indicating a persistent leak). We decided to intervene. Initially our guidewire couldn't cross the site of leak and contrast showed a sharp cutoff. We switched from an 0.035 inch to an 0.025 inch wire and were successful in crossing the structure site (A: black arrow). Further contrast injection showed leakage (B: Red arrow) and outlined the proximal bile ducts (B: White arrow indicates he proximal ducts and black arrow shows the site of ductal anastomosis/narrowing/leakage ). Since our papillotome had to be forced across the leak site, we decided to dilate it with dilatation catheters (C1 & C2: Dialatation being done with 5-6-7 French and 8-9-10 French graduated catheters, respectively ). A stent assembly was then passed into one of the proximal ducts (D: Black arrow) and a 10 French plastic stent of 12 cm length was passed (E: Black arrows).
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Second (actually 3rd) ERCP for post transplant biliary leak
This 60 year old gentleman had earlier undergone ERCP and stenting for an anastomotic biliary leakage a few months earlier http://ercp365.bl...
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This 60 year old gentleman had earlier undergone ERCP and stenting for an anastomotic biliary leakage a few months earlier http://ercp365.bl...
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This 40 year old lady had presented with a stricture of the CBD at the level of the cystic duct following a cholecystectomy. We had passed...
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