ASGE Endoscopy Live: Interventional EUS and Endo-Hepatology | July 2023-7-13-23 Endoscopy Live Case Demonstration 7

Video Transcription

Video Summary

In this video, Dr. Mohin Kashyap from Johns Hopkins demonstrates an EUS-guided direct transgastric ERCP procedure. The patient is a 47-year-old female with a history of obesity and laparoscopic gastric bypass. She presented with right upper quadrant abdominal pain and was diagnosed with choledogolithiasis and acute cholecystitis. The video shows the procedure, starting with distending the stomach using a 19-gauge needle and injecting contrast fluid for visualization. Dr. Kashyap then proceeds with the axis placement, using fluoroscopy to guide the positioning of the stent in the gastric body. There are some challenges due to the odd shape of the patient's stomach, but the procedure is successfully completed. A stent is placed, sludge is removed, and a bilirubin stent is inserted to hold the patient until gallbladder removal surgery. Dr. Kashyap discusses the importance of suturing the stent to prevent migration and the use of a 20mm stent to facilitate same-session ERCP. He concludes by explaining that the fistula will close by secondary intention once the stent is removed after the patient's cholecystectomy.

Asset Subtitle

Endoscopic Ultrasound Direct transGastric ERCP (EDGE)
Endoscopist: Dr. Mouen Khashab (Johns Hopkins Hospital)

Keywords

EUS-guided direct transgastric ERCP procedure

choledogolithiasis

acute cholecystitis

gastric bypass

stent placement