Double high-level disinfection versus liquid chemical sterilization for reprocessing of duodenoscopes used for ERCP

Post written by Mark A. Gromski, MD, from the Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA. This study aimed to answer whether there were any differences in 2 different duodenoscope reprocessing methods that fulfilled supplemental measures to enhance reprocessing: double high-level disinfection and liquid chemical sterilization. …

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EUS-guided jejunojejunostomy to facilitate ERCP in a patient with unique Roux-en-Y gastric bypass anatomy

Post written by Ryan Law, DO, from the University of Michigan, Ann Arbor, Michigan. In our case presentation we describe a patient who presented to our institution with concern for biliary pathology in the setting of prior Roux-en-Y gastric bypass with an indwelling percutaneous biliary drain. Importantly, this patient underwent a sleeve gastrectomy prior to …

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Bilateral balloon expandable biodegradable stent (Y-stent) for postcholecystectomy perihilar biliary stricture

Post written by Sundeep Lakhtakia, MD, DM, and Harsh Vardhan Tevethia, MD, DM, from the Department of Medical Gastroenterology, AIG Hospitals and Asian Institute of Gastroenterology, Hyderabad, Telangana, India. Following complicated laparoscopic cholecystectomy, a young woman developed a biliary stricture that required several ERCP sessions. She presented with recurrent jaundice. MRCP revealed a perihilar stricture …

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EUS-guided choledochoduodenostomy as a rescue after failed ERCP and percutaneous transhepatic biliary drainage in the management of postoperative benign biliary stricture

Post written by Sundeep Lakhtakia, MD, MNAMS, DM, FASGE, from the Department of Medical Gastroenterology, AIG Hospitals and Asian Institute of Gastroenterology, Hyderabad, Telangana, India. A young woman who had surgical choledocho-duodenostomy 5 years ago for biliary adverse events soon after cholecystectomy presented with biliary obstruction. MRCP revealed a smooth mid-CBD stricture, intra-hepatic stone with …

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Early precut versus primary precut sphincterotomy to reduce post-ERCP pancreatitis

Post written by Sudhir Maharshi, MD, DM, and Shyam Sunder Sharma, DNB, DM, from the Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India. The focus of our study was to assess the safety and efficacy of primary precut. It is well known that precut sphincterotomy, usually considered after repeated and failed cannulation, is …

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Use of a rigidizing overtube for altered-anatomy ERCP

Post written by Mike Tzuhen Wei, MD, from Stanford University, Stanford, and Veterans Affairs Palo Alto, Palo Alto, California. We present 2 cases in which the rigidizing overtube was used to facilitate performance of altered-anatomy ERCP. In the first case, a 53-year-old woman with history of Roux-en-Y hepaticojejunostomy presented for management of intrahepatic stones. Interventional …

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Gastric overtube use to prevent duodenoscope loop formation during EUS-directed transgastric ERCP procedure

Post written by Shelini Sooklal, MD, from the Division of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA. This video case demonstrates the technique of using a disposable gastric overtube device to aid passage of the duodenoscope through a previously placed lumen apposing metal stent (LAMS), from the roux limb to the remnant …

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Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures

Post written by Mohan Ramchandani, MD, from the Asian Institute of Gastroenterology Hospitals, Hyderabad, India. The aim of this study was to assess the diagnostic accuracy of digital single-operator cholangioscopy (DSOC) compared with ERCP-based assessment using traditional sampling technology in patients with indeterminate biliary strictures (IBS). Indeterminate biliary stricture was defined as a suspected intrinsic …

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Type VI choledochal cyst diagnosed on ERCP with direct cholangioscopy

Post written by Lawrence Ku, MD, from the Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA. This case highlights the diagnostic dilemma of differentiating between 2 types of choledochal cysts, type II versus type VI. Although rare, these choledochal cysts have significant malignant potential, ranging from 5 to 7.5%. Malignant transformation of type VI …

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Electrohydraulic lithotripsy through a fistula of EUS-guided hepaticogastrostomy

Post written by Tatsuya Sato, MD, Yousuke Nakai, MD, PhD, from the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. A 50-year-old man with a history of hepaticojejunostomy and Roux-en-Y reconstruction suffered from recurrent cholangitis due to bilateral intrahepatic stones. After failed double-balloon endoscope-assisted ERCP and percutaneous transhepatic biliary drainage, …

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