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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

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144,991 просмотров • 8 дней назад •via X (Twitter)

Наука и технологииОбразованиеЗдоровье и велнес#gitwitter#surgery#medx
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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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Working my way through the muscular bar in a patient with a HUGE Zenker's diverticulum using the SB Knife. So effective for the patient! #gitwitter #dysphagia #surgery
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Working my way through the muscular bar in a patient with a HUGE Zenker's diverticulum using the SB Knife. So effective for the patient! #gitwitter #dysphagia #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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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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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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Another shocking incident of violence against a female doctor has surfaced at PGIMER, one of India's top medical institutions. The doctor faced threats and false accusations of patient negligence from the patient's relatives. #MedTwitter #medX
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Another shocking incident of violence against a female doctor has surfaced at PGIMER, one of India's top medical institutions. The doctor faced threats and false accusations of patient negligence from the patient's relatives. #MedTwitter #medX

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Tips for Retrieval of CBD Stone during Transcholedochal LCBDE 🔴CBD >8mm 🔴Atraumatic graspers useful 🔴"Milking" CBDS 🔴5mm choledochoscope with 0-Tip basket ➡️Gentle "to-and-fro" motion ➡️Irrigation 🔴Withdraw choledochoscope over basket wire with trapped CBDS 🔴Extend choledochotomy #FOAMed #GITwitter #Surgery #SoMe4Surgery #HPB
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Tips for Retrieval of CBD Stone during Transcholedochal LCBDE 🔴CBD >8mm 🔴Atraumatic graspers useful 🔴"Milking" CBDS 🔴5mm choledochoscope with 0-Tip basket ➡️Gentle "to-and-fro" motion ➡️Irrigation 🔴Withdraw choledochoscope over basket wire with trapped CBDS 🔴Extend choledochotomy #FOAMed #GITwitter #Surgery #SoMe4Surgery #HPB

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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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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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Urgent attention required! The Goa Minister's actions towards a GMC doctor, including suspension without enquiry and public humiliation, are appalling.. Is this acceptable behaviour with a Senior Doctor ? Dr. Pramod Sawant and CMO Goa #MedTwitter #medX

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