Noäi Soi Medic: Endoscopic Techniques of Sphincterotomy and Removing Common Bile Duct Stones
Noäi Soi Medic: Endoscopic Techniques of Sphincterotomy and Removing Common Bile Duct Stones
Noäi Soi Medic: Endoscopic Techniques of Sphincterotomy and Removing Common Bile Duct Stones
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM
CME
ENDOSCOPIC TECHNIQUES OF
SPHINCTEROTOMY AND
REMOVING COMMON BILE DUCT
STONES
NOI SOI
MEDIC
NGUYEN PHUC BAO HUNG - MD
Endoscopist - MEDIC
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1. Anatomic consideration:
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Figure 1 : The anatomy of the descending uodenum, with the
intramural segment of the distal common bile duct
cephalad to the papilla of Vater. Folds of the plicae duodeni
longitudinalis run cephalad and end at the papilla.
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Figure 2 : Normal papilla is seen on the medial
duodenal wall, with longitudinal folds just below
it. The configuration is papillary or protruding.
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Figure 5 :
(A) Dormia basket catheter.
(B) Close-up of Dormia
basket.
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Figure 6 :
(A)
Balloon
catheter
(American
Edwards Co) for
extraction of bile
duct stones.
(B) Fully inflated
1-cm
diameter
balloon
of
balloon
extraction
catheter.
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Figure 7 : A mechanical lithotriptor can be used
to surround large or difficult stones and crush
them.
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Biopsy forceps.
X- ray machine with monitor.
Suction machine.
Medicine:
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Sedation : hypnovel, seduxen.
Antispasm: buscopan, glucagon.
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3. Techniques of endoscopic
sphincterrotomy for common bile
(A) Patient preparation : duct stones :
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(B) Technique :
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Once
the
endoscopic
retrograde
cholangio-pancreatography (ERCP) is completed,
the cannula is removed and if there is a need for
papillotomy, a proper papillotome is reintroduced
through the biopsy channel and advanced into the
common bile duct.
Proper placement of the papillotome in the
common bile duct should be permanently
documented by fluoroscopy or a radiograph. If
access to the common bile duct is difficult, the
endoscopist should leave the cannula in place and
insert a long wire through the cannula into the
common bile duct and then remove the cannula.
This will allow the use of the wire -guided
papillotome and easier access for insertion of the
papillotome into the common bile duct and then
remove
a
long
wire
and
withdraw
the
sphincterotome from the common bile duct until a
small portion of the papillome is visible in the
duodenum.
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The sphicterome is placed in the duct and
cutting will be proced
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The sphincterotomy is complete and sphincterotome will be
pulled off the bile duct.
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Endosopic sphincterotomy is accomplished
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Fig- 8 : Cholelithiasis with multiple gallstones
and a single common bile duct stone (arrow).
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Fig-8 (cont) :
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Figure 9 : A balloon
catheter is placed
and inflated (arrow)
after
papillotomy
and
is
used
to
extract the calculus.
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Figure 11 : Stages of removing common bile
duct stones by basket.
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ERCP:
stones
in
commo
n
bile
duct
and
commo
n
hepatic
duct
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Stones are pulled from common bile duct into the
duodenum.
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Endoscopic
sphincterotomy
has
helped
treatment of biliary and pancreatic diseases
easier and simpler.
Today
with
the
advent
of
endoscopic
sphincterotomy, the morbidity and mortality of
stone extraction is possibly less than with
surgical removal.
The hospital stay is shorter, revovery and return
to work is much quicker and the most important,
the patients feel less painful.
In MEDIC center, patient can be removed
common bile duct stones and come back their
home in 24 hour after the procedure.
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