ASGE DDW Videos from Around the World | 2022-LITHOTRIPSY WITH SPYBITE IN HEPATOLITHIASIS DURING PERCUTANEOUS/ENDOSCOPIC RENDEZ-VOUS AND SPYGLASS

Video Transcription

Lithotripsy with a spy bite in the patholytesis during percutaneous endoscopic rendezvous and spyglass.  The clinical case was a male of 63 years old with a clinical history of a severe sudden abdominal pain reporting jaundice and fever.  The comorbidities have systemic arterial hypertension with a surgical history of cholecystectomy  12 years ago and the physical examination presented jaundice and pain foam on deep palpation  of the abdomen and the laboratory have white blood cells over 1,200 and a total bilirubin of 6.1.  The patient was submitted to MRCP that shown multiple calculus on the common bioduct and  the intraepatic on the segments 3 and 4 with a final diagnosis of a moderate acute cholangitis.  The initial therapeutic choice was a percutaneous transepatic biliary drainage due to the difficulty expected to the ERCP get the fully clearance of the biliary tract.  After seven days, we perform a rendezvous percutaneous endoscopic ERCP with papillotomy and a balloon dilation of the papilla until 20 millimeters.  After dilation, we perform the complete extraction of the biliary stones of the common bioduct with extraction balloon.  After five days, a control cholangiography shows remaining stones in the common bioduct and in the segments 3 and 4.  To perform the treatment of the remaining stones, we indicated a percutaneous antigrade cholangioscopy.  We identify the stone on the common bioduct and then perform a mobilization until the duodenum.  After clearing the common bile duct, we saw a mucosa with irregularity and then we perform a biopsy with a SpyBite.  To access the segments 3 and 4 of intraepatic biliary duct, we perform a retrograde cholangioscopy.  In the segment 4, the intraepatic calculus was fragmented with a spi-bite.  After fragmentation, we remove all the piece of the stones with a spi-bite.  And now you can see the guide wire located in the hepatic segment 3, due to a remaining stone.  After the placement of the guide wire, we could remove the remaining stones on the segment 3 with extraction below. Control column geography shown no remaining stones.

Video Summary

In this video, a 63-year-old male patient with a history of abdominal pain, jaundice, and fever underwent lithotripsy with a spy bite in the patholysis during percutaneous endoscopic rendezvous and spyglass. The patient had comorbidities of systemic arterial hypertension and a past cholecystectomy. The initial diagnostic tests revealed multiple calculi in the common bile duct and intrahepatic segments 3 and 4, leading to a diagnosis of moderate acute cholangitis. Initially, a percutaneous transepatic biliary drainage was performed. After seven days, a rendezvous percutaneous endoscopic ERCP with papillotomy and balloon dilation was carried out to extract the remaining stones. However, a follow-up cholangiography revealed persistent stones. To address this, percutaneous antegrade cholangioscopy was recommended. Using a SpyBite, a biopsy was performed on the common bile duct, and a retrograde cholangioscopy was conducted to access and remove stones in the intrahepatic segment 4. A guide wire was then placed in segment 3 to remove the remaining stones. Subsequent cholangiography showed no remaining stones.

Keywords

abdominal pain

jaundice

fever

lithotripsy

cholangitis