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

Video Transcription

Video Summary

In this video, doctors discuss the case of an 88-year-old female with a history of rheumatoid arthritis and prior cholecystectomy who was admitted to the hospital with postprandial abdominal pain. Her liver enzymes were elevated, and MRI and MRCP showed a dilated bile duct with no evidence of obstruction or stones. An attempted ERCP was unsuccessful due to the location of the papilla within a large perianfilary diverticulum. The patient also experienced symptoms of intermittent postprandial nausea, vomiting, abdominal distension, and weight loss. The doctors discuss the possibility of a cortical cyst, but note that the intrahepatic dilation is more significant than expected. They suggest that an obstructive process is more likely, but the cause is unclear. They proceed with an EUS-guided intervention to access the biliary system and plan to perform a cholangiogram to further evaluate the condition. The doctors also discuss the possibility of a hepaticogastrostomy and a fully covered stent placement to provide drainage for the patient.

Asset Subtitle

Mouen Khashab, MD

Keywords

cholecystectomy

dilated bile duct

obstruction

EUS-guided intervention

cholangiogram

hepaticogastrostomy