Biliary - Wallstent, Trimming with APC
Comments: This 76 year old lady is six months s/p Wallstent placement for unresectable pancreatic adenocarcinoma and presents with weakness, melena, and an hematocrit of 16%. On endoscopy, the uncovered Wallstent is revealed to have migrated 2-3 cm down the bile duct causing deep ulceration of the opposite duodenal wall. Endoscopic removal of this stent is not an option. Instead the argon plasma coagulation unit is used to cut the intraduodenal portion of the Wallstent. Under conscious sedation, and with APC settings of 80 watts, and an argon flow rate of 0.8 liters/minute, a forward firing probe is used through the side viewing duodenoscope to cut through the wire mesh. The probe is fired in close apposition to the mesh and is targeted on a single site until that area is cut. At these setting the total cutting time was fifteen minutes. When completed, the exposed and deeply ulcerated duodenal mucosa is more clearly visualized. The cut Wallstent fragment was snared, collapsing the wires and then the entire fragment was removed without difficulty. The patient had no further bleeding.
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Peter B. Kelsey, M.D. Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital |
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Citation: Kelsey, PB (Feb 21 2006). Biliary - Wallstent, Trimming with APC. The DAVE Project. Retrieved Feb, 9, 2010, from http://daveproject.org/viewfilms.cfm?film_id=294 Times viewed since Feb 2006: 9658 |
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