ASGE Endoscopy Live: Interventional EUS and Endo-Hepatology (On-Demand) | 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 endoscopic ultrasound-guided transgastric ERCP procedure on a 47-year-old female patient who had undergone gastric bypass surgery five years prior. The patient presented with right upper quadrant abdominal pain and was diagnosed with choledogolithiasis and acute cholecystitis. The ultrasound showed a four-millimeter stone in the common bile duct, along with gallstones. Dr. Kashyap uses a 19-gauge needle to distend the remnant stomach and performs a gastro-gastrostomy to create an access point. He then proceeds with the ERCP procedure, inserting a stent and removing sludge. The procedure encountered some difficulties, with the stent getting stuck and requiring the use of a wire to resolve. Dr. Kashyap sutures the stent to prevent migration and discusses the rationale for choosing the target area in the stomach. The video concludes with a discussion on the patient's post-procedure care and the decision to remove the stent after the patient undergoes cholecystectomy.

Asset Subtitle

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

Keywords

endoscopic ultrasound-guided transgastric ERCP procedure

gastric bypass surgery

choledogolithiasis

acute cholecystitis

common bile duct stone