ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence

Video Transcription

Video Summary

The session began with discussions about biliary and pancreatic endoscopy, specifically focusing on the management of large bile duct stones. Dr. Praveen Chahal presented practical tips for treating large bile duct stones, emphasizing that about 80-85% can be managed with endoscopic techniques, including balloon dilation and lithotripsy. Dr. Chahal highlighted the importance of removing stones to prevent complications such as pancreatitis and cholangitis, noting that the risk increases with the stone's size. She explained different techniques and tools for stone removal, including endoscopic papillary balloon dilation, lithotripsy, and stent use. She emphasized the need for careful assessment of the bile duct size and stone to choose the appropriate treatment method.<br /><br />Dr. James Buxbaum discussed post-ERCP pancreatitis (PEP), stating it is commonly underdiagnosed, leading to significant patient stress and complications. He suggested avoiding unnecessary ERCP to minimize the risk and highlighted the effectiveness of pancreatic stents, rectal NSAIDs, and wire-guided cannulation in preventing PEP. He emphasized avoiding diagnostic ERCP when possible, especially in low-probability cases.<br /><br />Dr. Raj Keswani addressed ERCP quality, indicating the variability in ERCP outcomes could significantly impact patient mortality, particularly emphasizing the importance of correct cannulation. He suggested improving ERCP quality through appropriate indications, technique enhancements, and cannulation success rates.<br /><br />The session concluded with a debate on the use of plastic versus metal stents in managing hyaluron tumors. Dr. Raj Shah advocated for plastic stents due to their simplicity, feasibility of re-intervention, and adaptability to medical advancements, whereas Dr. Martin Freeman supported metal stents for their superior patency and fewer repeat interventions, emphasizing proper technique in placement to avoid complications. This highlighted different perspectives and considerations in endoscopic management of biliary obstructions.

Keywords

biliary endoscopy

pancreatic endoscopy

bile duct stones

endoscopic techniques

balloon dilation

lithotripsy

post-ERCP pancreatitis

pancreatic stents

ERCP quality

cannulation

plastic stents

metal stents

biliary obstructions