ASGE Endoscopy Live: Pancreatobiliary Cases and Updates (On-Demand)

Video Transcription

Video Summary

In this video, Dr. Raj Shah from the University of Colorado performs a cholangioscopy procedure on a patient with a large bile duct stone. The initial attempt at stone extraction using conventional methods was unsuccessful, so cholangioscopy was deemed necessary. Dr. Shah uses a laser fiber to break up the stone, which is located below the duodenoscope crossing the bile duct. He explains the technique of using laser energy to fracture the stone and mentions the advantages of using laser over electrohydraulic lithotripsy (EHL) for difficult stones. Throughout the procedure, Dr. Shah faces challenges with positioning and stability due to the patient's anatomy, as well as difficulties with visualization caused by fragmented stone debris. He discusses the potential risks of mucosal injury and the need for multiple sessions to fully clear the stone. Dr. Shah also addresses questions from other experts in the video, including the potential use of disposable scopes, the timing of post-procedure antibiotics, and the safety of retrieving stones with a balloon or basket in the presence of mucosal injury. The video ends with fluoroscopy images showing the stone fragments being successfully removed with a balloon.

Asset Subtitle

Raj Shah, MD

Keywords

cholangioscopy procedure

bile duct stone

stone extraction

laser fiber

fracturing stone

difficult stones

mucosal injury