This was the 4th ERCP this lady was undergoing. She had originally been referred for treatment of a post cholecystectomy CBD stricture. Her first ERCP was done in July ( just before I started this blog). She had undergone balloon stricturoplasty followed by plastic stent placement during her second (September) http://ercp365.blogspot.com/2013/09/post-cholecystectomy-cbd-stricture.html and third (December) http://ercp365.blogspot.com/2013/12/follow-up-case-of-post-cholecystectomy.html ERCPs. We removed her previous plastic stent and did a cholangiogram which showed persistence of the stricture (A: white arrow), albeit less than previously. We did a repeat balloon stricturoplasty using a 10mm x 30mm TTS balloon (B: white arrow). Repeat cholangiogram showed widening of the structured segment (C: white arrow). We decided to place two stents again (only one had been placed at her last ERCP). Two guidewires were placed across the selected segment (D: white & red arrows). This was followed by deployment of two plastic stents, each of 10 French diameter and 10cm length (E1 & E2: white & red arrows). She will be reassessed after eight weeks.
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