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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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Douglas G. Adler MD, FASGE, FACG, AGAF

17,398 subscribers

147,309 просмотров • 1 месяц назад •via X (Twitter)

Наука и технологииОбразованиеЗдоровье и велнес#gitwitter#surgery#medx
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Комментарии: 4

Фото профиля Alan Hay
Alan Hay1 месяц назад

Urologists are unimpressed.

Фото профиля Gastro endoscopy issues Dr Mohamed Hussien
Gastro endoscopy issues Dr Mohamed Hussien1 месяц назад

Not only so satisfying for the Endoscopiest and the patient,but also Me ...Good job

Фото профиля Sudarshana Chakra 3.0
Sudarshana Chakra 3.01 месяц назад

Sir which position of the patient is better for beginners ? Prone or supine ?

Фото профиля Jhoan M Carvajal G
Jhoan M Carvajal G1 месяц назад

Pleasure of life

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

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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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Douglas G. Adler MD, FASGE, FACG, AGAF

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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, FASGE 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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The value of Transvesical-assisted cystic pedicle dissection. A large stone appearing at ? Hartman Pouch, ? GB neck. 1- never dissect proximal to stone 2- never assume it is in HP 3- immediately suspect Mirizzi 4- accessing the stone through the GB will help either transvesical removal or dislodgement and facilitate extraction 5- Mirizzi 2 becomes obvious 6- NEVER MIND THE CVS, you risk major duct injury. Transfistula IOC and exploration will be mandatory to guide further dissection. 7- choledochoscopy aids further anatomical confirmation. Seeing the scope light in the hepatocystic triangle while the scope is in the RHD , and with no irrigation fluid escaping duct system slows down the surgeons pulse and stems his/her sweat > the ducts are intact. 8- extract any further stones and insert a transfistula t-tube. No sutures needed but obviously a good subhepatic drain until no bile is seen, t tube remains for four weeks to allow healing of the fistula. Avoid early postop cholangiography ( it can cause contrast and bile leakage with potential pain/peritoneal irritation which slows down the healing and may force reintervention.

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