What is going on in there?
Devices
Complications
We're Obstructed
Procedural Steps
100
List malignant biliary strictures
adenocarcinoma
cholangiocarcinoma
metastatic tumors
100
This device can be used to sweep stones out of the bile duct.
Extractor Balloon
100
What are the two biggest challenges for a MD during an ERCP?
Gaining & maintaining access
100
True or false: There are both benign and malignant strictures
TRUE :)
100
What device is used to perform a sphincterotomy?
sphinctertome
200
True or False: Stones can be found in the pancreatic duct.
TRUE, rarely.
200
After a stone extraction, this may be placed to restore patency, maintain drainage, and reduce the risk of cholangitis:
plastic stent
200
If a patient needs a plastic biliary stent, how long can the stent be in the duct?
up to 3 months
200
Can a stent be reconstrained during the deployment process?
yes
200
What is the exchange method called?
pinch and pull
300
How do you know you're in the CBD and not the PD?
PD goes towards the spine and the CBD runs parallel to the spine
300
What is the most common balloon size?
9-12mm
300
If a balloon does not work, what other methods can be used to extract stones?
Basket to catch/crush stones
Dilation to assist stone removal
Spyglass with EHL
300
What is causing this obstruction?
Stones
300
This is injected to view the biliary tree to identify location and size of stones or strictures.
contrast
400
Name two imaging options for biliary stricture diagnosis
CT scan
EUS
MRI
400
What do you fill a hurricane balloon with?
contrast
400
Name 3 indications for ERCP?
Jaundice, Pancreatitis , and Biliary obstruction
400
How many diamonds should you see endoscopically when a Wallflex metal stent is fully deployed ?
3-4 diamonds
400
What must you do before you hand the tome to the MD?
Prime it
500
Describe the difference between cholelithiasis and choledocholithiasis.
cholelithiasis: stones in the gallbladder
choledocholithiasis: stones in the bile duct
500
List 2 reasons why a patient would need a biliary stent?
biliary stricture
bile duct leak
failure to remove stones
500
How do we know what size balloon to use?
depends on anatomy of patient and how tight the stricture is
500
What does DASE stand for and what does this method do?
Dilation Assisted Stone Extraction
It provides the ability to dilate the ampulla post sphincterotomy to facilitate stone removal
500
Why do we prime the tome?
Do not want air in the tome as the air can be mistaken as stones .