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Beautiful biliary sphincterotomy to remove a large impacted bile duct stone during ERCP! #gitwitter #surgery

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Douglas G. Adler MD, FASGE, FACG, AGAF

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2,206,917 görüntüleme • 9 gün önce •via X (Twitter)

Bilim & TeknolojiEğitimSağlık & İyilik#gitwitter#surgery
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Sphincterotomy with impacted bile duct stone removal during ERCP. So satisfying for the doctor and the patient! #gitwitter #surgery #medx
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Sphincterotomy with impacted bile duct stone removal during ERCP. So satisfying for the doctor and the patient! #gitwitter #surgery #medx

Douglas G. Adler MD, FASGE, FACG, AGAF

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Saturday morning sphincterotomy. #gitwitter #surgery #ERCP
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Saturday morning sphincterotomy. #gitwitter #surgery #ERCP

Douglas G. Adler MD, FASGE, FACG, AGAF

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Beautiful video: Raptor forceps to remove a plastic biliary stent that migrated & perforated the contralateral wall of the 2nd duodenum. Perforation closed w/ clips & pt treated with oral antibiotics to good effect. #gitwitter #surgery Tamta Chkhikvadze Andy Tau, MD Saurabh Chandan, MD Achintya Singh, MD
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Beautiful video: Raptor forceps to remove a plastic biliary stent that migrated & perforated the contralateral wall of the 2nd duodenum. Perforation closed w/ clips & pt treated with oral antibiotics to good effect. #gitwitter #surgery Tamta Chkhikvadze Andy Tau, MD Saurabh Chandan, MD Achintya Singh, MD

Douglas G. Adler MD, FASGE, FACG, AGAF

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𝗦𝘁𝗼𝗻𝗲 𝗥𝗲𝘁𝗿𝗶𝗲𝘃𝗮𝗹 𝗳𝗿𝗼𝗺 𝗡𝗮𝗿𝗿𝗼𝘄 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 🔴Bring CBD stone trapped in basket to choledochotomy site 🔴Remove scope over wire 🔴Keep tension on basket wire with trapped CBD stone 🔴Introduce choledochotome (or laparoscopic scissors) and minimally extend choledochotomy over large CBD stone ➡️Prevents large choledochotomy #FOAMed #GITwitter #MedEd #SoMe4Surgery #Surgery
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𝗦𝘁𝗼𝗻𝗲 𝗥𝗲𝘁𝗿𝗶𝗲𝘃𝗮𝗹 𝗳𝗿𝗼𝗺 𝗡𝗮𝗿𝗿𝗼𝘄 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 🔴Bring CBD stone trapped in basket to choledochotomy site 🔴Remove scope over wire 🔴Keep tension on basket wire with trapped CBD stone 🔴Introduce choledochotome (or laparoscopic scissors) and minimally extend choledochotomy over large CBD stone ➡️Prevents large choledochotomy #FOAMed #GITwitter #MedEd #SoMe4Surgery #Surgery

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Transpancreatic sphincterotomy... a technique to aid in difficult biliary cannulation Published evidence suggest it is safe and effective However, many experts feel cutting through pancreatic sphincter is risky and/or unnecessary Views #GITwitter? How many use this technique?
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Transpancreatic sphincterotomy... a technique to aid in difficult biliary cannulation Published evidence suggest it is safe and effective However, many experts feel cutting through pancreatic sphincter is risky and/or unnecessary Views #GITwitter? How many use this technique?

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Tips for Transcystic Laparoscopic CBD Exploration 🔴3mm choledochoscope ➡️Direct visualisation of duct 🔴Cephalad retraction 🔴Incise cystic duct parallel to CBD stone 🔴If large CBD stone ➡️withdraw scope over wire and provide gentle traction 🔴Milk backwards 🔴Keep CBD in view 🔴Reduce speed of irrigation to trap CBDS What are your tips and tricks for transcystic LCBDE? #FOAMed #GITwitter #surgery #hpb #MedEd #SoMe4Surgery
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Tips for Transcystic Laparoscopic CBD Exploration 🔴3mm choledochoscope ➡️Direct visualisation of duct 🔴Cephalad retraction 🔴Incise cystic duct parallel to CBD stone 🔴If large CBD stone ➡️withdraw scope over wire and provide gentle traction 🔴Milk backwards 🔴Keep CBD in view 🔴Reduce speed of irrigation to trap CBDS What are your tips and tricks for transcystic LCBDE? #FOAMed #GITwitter #surgery #hpb #MedEd #SoMe4Surgery

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How many of you use default settings on your endosurgical generator for sphincterotomy during ERCP? How many of you have personalized settings? I always use personalized settings based on my experience and preference. What do you do? Please RT and answer below. #GItwitter
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How many of you use default settings on your endosurgical generator for sphincterotomy during ERCP? How many of you have personalized settings? I always use personalized settings based on my experience and preference. What do you do? Please RT and answer below. #GItwitter

Douglas G. Adler MD, FASGE, FACG, AGAF

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Applying PuraStat to a sphincterotomy bleed after hemostatis was achieved with a Gold Probe to reduce the risk of rebleeding. Very effective in my experience! #gitwitter
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Applying PuraStat to a sphincterotomy bleed after hemostatis was achieved with a Gold Probe to reduce the risk of rebleeding. Very effective in my experience! #gitwitter

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Impacted large pigmented stone at the ampulla of Vater - great way to practice free-hand needle knife papillotomy. Note the gush of pus and bile seen after stone removal. ERCP will always be one of the most satisfying interventional endoscopy procedures. Aymen Almuhaidb, MD Mohammad Bilal, MD Turki AlAmri |تُرْكي عبدالله الْعَمريَّ MD Ramzi Mulki, MD Tom Tielleman, MD Thomas R McCarty Michelle Baliss, DO Judy Trieu, MD, MPH Douglas G. Adler MD, FASGE, FACG, AGAF Nadeem Tehami Sajjad Mahmood Keith Siau
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Impacted large pigmented stone at the ampulla of Vater - great way to practice free-hand needle knife papillotomy. Note the gush of pus and bile seen after stone removal. ERCP will always be one of the most satisfying interventional endoscopy procedures. Aymen Almuhaidb, MD Mohammad Bilal, MD Turki AlAmri |تُرْكي عبدالله الْعَمريَّ MD Ramzi Mulki, MD Tom Tielleman, MD Thomas R McCarty Michelle Baliss, DO Judy Trieu, MD, MPH Douglas G. Adler MD, FASGE, FACG, AGAF Nadeem Tehami Sajjad Mahmood Keith Siau

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