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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

16,946 subscribers

144,991 görüntüleme • 8 gün önce •via X (Twitter)

Bilim & TeknolojiEğitimSağlık & İyilik#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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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

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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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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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Many people think colonic stents are only for use on the left colon. This is TOTALLY FALSE! Here is a great video of a 22x90 mm colonic stent being deployed across the IC valve in a pt with obstructing cecal cancer. #gitwitter #surgery #medx #medtwitter

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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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I LOVE aspirating knees! So satisfying for the patient AND me!! Feels better than popping a zit! 😂. Patient wanted to record it. I said, “sure. . . and airdrop me!” 😂
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Dr. Caleb Masterson say health insurance companies are openly breaking laws in Alabama He explains some of his patients situations with insurance companies - “I had an insurance company tell a patient that no authorization for the procedure was required, the procedure was performed, and then the patient was denied the care because the procedure was never authorized. So the patient got charged the entire cost of the procedure” - “I had another patient who is supposed to be due an answer to an insurance claim within 30 days of submission. If they do not reply within 30 days, that's breaking Alabama law. And that claim is currently at the 65th day, so its insurance can be breaking the law.” - “Then I had an insurance company deny care to a patient that they had previously approved. So a patient qualified for surgery based on medical necessity, they had met all the criteria for surgery, they underwent surgery, then the patient had that surgery denied. The patient submitted that information to the insurance company and said, Hey, look, this was already pre-approved. And they said, We reversed our decision and the patient had to pay.”

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Just got my hands on this NEW fully rotatable sphincterotome! The rotation is silky smooth & adds the final degree of freedom missing in tip control so badly needed in: intra-dochal (hilar, cystic), altered anatomy ERCP and papilla in duodenal diverticulum! #GITwitter

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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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