Biliary - ERCP with DACP without Fluoro in Morbid Obesity
Comments: This 23 year old, 350 lb woman was referred for ERCP after laparoscopic cholecystectomy revealed retained CBD stones. Due to her size, ERCP was performed using DACP without fluoroscopy. The ampulla was cannulated using a papillotome guide wire combination. Once the papillotome was deeply positioned in the duct, the guide wire was slowly withdrawn. The finding of bile in the lumen of the papillotome confirmed the position of the catheter to be within the bile duct. Papillotomy could then be safely performed.
DACP without the use of fluoroscopy has been used in several groups of patients including those who are too critically ill to travel to a fluoroscopy unit, during pregnancy, and in some morbidly obese patients as in this example.
Once an adequate papillotomy had been completed the papillotome is removed. And the DACP scope is passed free- hand into the biliary system. Initial visualization of the intrahepatic biliary radicals in the region of the bifurcation demonstrated these two yellow facetted cholesterol stones. The cystic duct was also examined. No stones were found in this area. The superficial injury seen here probable occurred during the cholangiogram obtained during the cholecystectomy and is of no consequence. The stones were flushed from the biliary system using a balloon catheter. The patient's course was uneventful and she was discharged the following day.
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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 (Dec 04 2003). Biliary - ERCP with DACP without Fluoro in Morbid Obesity. The DAVE Project. Retrieved Sep, 6, 2010, from http://daveproject.org/viewfilms.cfm?film_id=33 Times viewed since Feb 2006: 6289 |
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