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

Video Transcription

Video Summary

In this video, the speaker discusses various questions related to the use of metal stents for treating bile duct strictures. They discuss whether the distal end of the stents should cross into the duodenum, the use of eight millimeter stents for patients with normal diameter ducts, and the placement of stents above or below the papilla. The speaker mentions that studies have shown no clear answer to these questions and that either approach is legitimate. They also emphasize that patients are now living longer with biliary strictures, so the need for revision procedures should be considered. The speaker recommends using a supra pilar metal stent that crosses the papilla to make reaccessing it easier in the future. They also discuss balloon dilation and catheter dilation for strictures and suggest using a balloon dilator for easier use. They mention the use of various stents and devices for different situations and the importance of measuring stent length accurately. The speaker also addresses duct-to-duct anastomotic strictures in transplant patients and recommends balloon dilation followed by stenting for improved patency. They caution against the use of fully covered metal stents without consulting with the transplant surgery team first.

Keywords

metal stents

bile duct strictures

duodenum

eight millimeter stents

placement of stents