ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual)

Video Transcription

Video Summary

In this video, a case of possible biliary obstruction is discussed. An 88-year-old female with a history of rheumatoid arthritis and prior cholecystectomy presents with postprandial abdominal pain, elevated liver enzymes, and a dilated intra and extrahepatic bile duct. An attempted ERCP at another hospital was unsuccessful due to the papilla being located within a large perianfilary diverticulum. The patient also experiences symptoms of intermittent postprandial nausea, vomiting, abdominal distention, and weight loss. The plan is to evaluate her endoscopically to determine the cause of her symptoms and to perform EUS-guided interventions and ERCP. Dr. Khashab uses EUS to visualize the dilated bile duct and attempts to pass a wire through the papilla. If unsuccessful, the plan is to perform a hepatogastrostomy and place a fully covered stent to provide drainage for the bile duct. The potential of a colidoco cyst is also considered. The procedure is ongoing and further steps are discussed by Dr. Khashab and the medical team.

Asset Subtitle

Mouen Khashab, MD

Keywords

biliary obstruction

ERCP

dilated bile duct

endoscopy

hepatogastrostomy

colidoco cyst