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

Video Transcription

Video Summary

In this video, the speaker discusses a case of a middle-aged gentleman with cholangitis and a 1.3 cm stone in his duct. They plan to perform an edge-directed transgastric ERCP. The speaker explains the technique used to confirm the location of the remnant stomach before proceeding. They also highlight the importance of confirming the location to avoid complications. The speaker demonstrates the steps of filling the stomach with contrast and saline, and then deploying a 20 mm Axios stent using a 19 gauge needle. They emphasize the need to anchor the stent to prevent migration and perforation. The speaker discusses the option of suturing versus clipping the stent, and highlights the importance of drainage in this patient with cholangitis. Due to the difficulty of the procedure, the speaker decides to postpone the ERCP and perform sphincteroplasty during a later session. They mention the option of dilating next to a stone, although there may be some added risk. The video ends with discussions of post-procedure recommendations and the potential benefits of completing the procedure in one stage for accessibility in case of post-ERCP complications. No credit is provided for the video.

Asset Subtitle

Mouen Khashab, MD

Keywords

cholangitis

stone

duct

transgastric ERCP

Axios stent

sphincteroplasty

post-procedure recommendations