On the Bleeding Edge: Mastering GI Emergencies and Inpatient GI Consultation (On-Demand)

Video Transcription

Video Summary

The speaker reviewed inpatient biliary emergencies, acute pancreatitis management, and prevention of post-ERCP pancreatitis. He emphasized avoiding diagnostic ERCP when EUS or MRCP can clarify an uncertain diagnosis, and targeting high cannulation success through appropriate indications and experienced practice.<br /><br />For cholangitis, severity guides timing: unstable patients with organ dysfunction need emergent biliary drainage, while stable moderate cases can generally receive antibiotics and ERCP within 24–48 hours. In acute infection, prioritize drainage over sphincterotomy and stone extraction, which can be addressed after stabilization. Painless jaundice from a suspected malignancy is usually not an overnight emergency. For suspected bile-duct stones, use risk assessment to direct patients to ERCP, EUS/MRCP, or surgery. Large or difficult stones may require lithotripsy or cholangioscopy; size dilation to the bile duct and avoid dilating over an impacted stone.<br /><br />Other practical points included stenting bile leaks, treating post-sphincterotomy bleeding with targeted therapy, and changing cannulation strategies early when access is difficult. For biliary pancreatitis, urgent ERCP is generally unnecessary without cholangitis or worsening obstruction; mild cases should receive same-admission cholecystectomy. Moderate fluid resuscitation and early feeding are favored. To reduce post-ERCP pancreatitis, use guidewire cannulation, rectal indomethacin, and pancreatic stents when the pancreatic duct is accessed.

Asset Subtitle

Christopher Chapman, MD

Keywords

biliary emergencies

acute pancreatitis

post-ERCP pancreatitis

cholangitis

ERCP

EUS/MRCP

bile duct stones

biliary drainage

cholecystectomy