ASGE Masterclass: Endoscopic Retrograde Cholangiopancreatography (ERCP) On-Demand

Video Transcription

Video Summary

In this video, John and Ashley discuss ERCP (Endoscopic Retrograde Cholangiopancreatography) in patients with altered anatomy. They emphasize the importance of understanding the patient's surgical anatomy before performing ERCP and recommend reviewing surgical notes and consulting with surgeons or surgical colleagues for valuable advice. They mention that some surgeons are adept at removing cystic duct stents during a laparoscopic cholecystectomy, while others are not, so it is best to consult with the individual surgeon. <br /><br />Ashley shares a technique called EUS (Endoscopic Ultrasound)-guided fistula creation in patients with RYGB (Roux-en-Y Gastric Bypass) who have intact gallbladders. By creating a fistula between the gastric pouch and the excluded stomach, ERCP can be performed without the need for laparoscopic assistance. This approach involves placing a lumen-apposing metal stent, which allows access for ERCP and subsequent interventions. Ashley highlights the importance of discussing the procedure with patients beforehand to manage their expectations and address potential issues with fistula closure.<br /><br />They also touch on using fluoroscopy, contrast injection, and wires during the procedure to ensure correct placement and stability. Ashley advises consulting with experienced practitioners and reaching out for advice when performing procedures outside of one's expertise. The video concludes with demonstrations of wire-guided stent placement and stone removal in patients with altered anatomy.<br /><br />No credits are mentioned in the video.

Keywords

ERCP

altered anatomy

laparoscopic cholecystectomy

EUS

RYGB

fistula creation

lumen-apposing metal stent

fluoroscopy