ASGE DDW Videos from Around the World | 2023-ENDOSCOPIC CHOLEDOCHOTOMY A DIFFERENT TECHNIQUE IN DIFFICULT BILIARY CANNULATION

ENDOSCOPIC CHOLEDOCHOTOMY A DIFFERENT TECHNIQUE IN DIFFICULT BILIARY CANNULATION

Video Transcription

Video Summary

The video presents a case of endoscopic colidocotomy in an 85-year-old female patient with gallstones and CBD stones. The patient had multiple periampullary diverticulae, making canalization challenging during ERCP. The standard techniques of using traction with a sphincterotome or pediatric biopsy forceps were not successful. The proposed approach was a direct needle knife dissection between the diverticulae, termed colidocotomy. The video explains the difference between colidocotomy and fistulotomy and highlights that colidocotomy is effective in experienced hands but can lead to retrodural perforation. The procedure involved using a sphingrotome and a hydrophilic guide wire for successful canalization and stone extraction. The bile duct was then cleared and a pigtail stent was placed, followed by cholecystectomy and stent removal at a later stage. The video emphasizes the key learning points, including the usefulness of endoscopic cholecystectomy in floppy papilla with multiple periampullary diverticulae, the need for caution to avoid complications, and the possibility of small CBD stone extraction and stenting. No credits were provided for the video.

Asset Subtitle

Honorable Mention

Keywords

endoscopic colidocotomy

gallstones

CBD stones

periampullary diverticulae

ERCP