ERCP-FORWARDS AND BACKWARDS - THREE ENDOSCOPES FOR BILIARY ACCESS

Video Transcription

Video Summary

In this video case, an 85-year-old male with urothelial cancer presented with symptoms of jaundice, fatigue, pruritus, and unintentional weight loss. The patient had difficulty with traditional methods of biliary drainage due to an unusual anatomical variant of the papilla. The medical team attempted various techniques, including double-wire technique and stenting, but were unsuccessful. They then decided to attempt biliary decompression through EUS-guided biliary drainage. After successful puncturing of the common bile duct, a stent was placed to facilitate bile drainage. The patient's bilirubin levels decreased, and further procedures were performed to obtain brushings and place a metal stent in the common bile duct. The patient's bilirubin continued to decrease, and cytology was negative for malignant cells. The video concludes that EUS-guided cholangiogram can evaluate biliary tree and cystic duct patency, and EUS-guided gallbladder drainage can relieve obstructive jaundice when a patent cystic duct is present. Rendezvous procedures can be performed using a cholecystogastrostomy and two scopes simultaneously. The ability to retroflex a small-caliber scope in the gallbladder aided in successful cannulation of the cystic duct. (No credits were mentioned in the transcript.)

Asset Subtitle

Honorable Mention

Keywords

urothelial cancer

jaundice

biliary drainage

EUS-guided biliary drainage

cystic duct patency