Stent-in-stent self-expandable metallic stent placement under direct cholangioscopy

Post written by Mitsuru Okuno, MD, PhD, from the Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan. Managing consequent jaundice caused by malignant hilar biliary obstruction (MHBO) is important. Endoscopic biliary drainage is the treatment of choice because of its limited invasiveness. However, in patients with surgically altered anatomy, especially those who have undergone Roux-en-Y …

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A case of hemobilia secondary to cancer of the gallbladder confirmed by cholangioscopy

Post written by Linda Zhang, MBBS, from the Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, Australia. This article discusses the management of hemobilia due to gallbladder malignancy in a frail, elderly patient with multiple comorbidities, which limited the available therapies. Our patient was a 90-year-old female who presented with biliary obstruction and melaena. …

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Balloon overtube-assisted cholangioscopy and laser lithotripsy of large bile duct stones

Post written by Jaehoon Cho, MD, and Ara B. Sahakian, MD, from the Department of Internal Medicine, Los Angeles County Hospital and University of Southern California Medical Center, and the Division of Gastrointestinal and Liver Diseases, University of Southern California Keck School of Medicine, Los Angeles, California, USA. In this video, we describe successful balloon …

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Electrohydraulic lithotripsy under double-balloon endoscope–assisted direct cholangioscopy

Post written by Tatsuya Sato, MD, from the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. This is a case report of double-balloon endoscope-assisted direct cholangioscopy in a patient with a history of total gastrectomy and Roux-en-Y (R-Y) reconstruction. Electrohydraulic lithotripsy (EHL) was necessary to remove large and multiple bile …

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Digital cholangioscopic evaluation of a post–liver transplantation stricture

Post written by Shyam Menon, MSc, MD, FRCP, from the Department of Liver Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom. Post liver transplantation anastomotic strictures can be technically challenging to manage. We describe a patient who presented a few months after liver transplantation with progressively deteriorating liver function tests and an episode …

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Completely obstructed bile duct? Let cholangioscopy guide the way

Gabriel D. Lang, MD, from the Division of Gastroenterology, Washington University, Saint Louis, Missouri, presents this video case. A 67-year-old female with locally advanced duodenal adenocarcinoma with previous metal biliary and enteral stents presented with jaundice. The cholangiogram demonstrated a complete obstruction at the proximal end of the stent. Multiple attempts to advance a variety …

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Esophageal stent for treatment of choledocholithiasis

Post written by Amy Tyberg, MD, from the Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA This case describes an elderly patient post-cholecystectomy with a markedly dilated bile duct and significant, persistent stone burden despite standard stone extraction techniques who ultimately achieved bile duct clearance with placement of a …

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