Advanced Endoscopy Fellows Program | September 2023-Presentation 3C

Presentation 3C - Hepatobiliary Video Case Discussions 3

Video Transcription

Video Summary

In this video, a case of a 20-year-old male who had a recent liver transplant is discussed. The patient presents with jaundice and elevated liver function tests in a cholestatic pattern. A main duct obstruction is identified on MRCP, and the patient is referred for ERCP for further evaluation. The discussion focuses on the importance of reviewing imaging before procedures, as well as the technique of stent placement. There is debate among the faculty about the appropriate stent to use in this case, considering the size mismatch between the donor and recipient bile ducts. Some suggest dilating the stricture before stent placement, while others suggest using a short stent to avoid navigating a difficult turn in the bile ducts. The faculty also discusses the possibility of sphincterotomy and the risk of pancreatitis. The video concludes with the placement of a biliary stent and the subsequent discovery of a bile leak. The endoscopist encounters technical difficulty in placing the stent and considers options for addressing the obstruction.

Keywords

liver transplant

MRCP

ERCP

stent placement

bile ducts

bile leak