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The purpose of biliary endoscopic sphincterotomy in the treatment of a bile leak is to reduce or eliminate the pressure gradient between the bile duct and the duodenum, encouraging transpapillary bile flow and allowing the leak to heal. [7] Others: Palliation of malignant biliary strictures; Gallbladder drainage; Biliary parasite removal; Sump ...
Other procedures associated with ERCP include the trawling of the common bile duct with a basket or balloon to remove gallstones and the insertion of a plastic stent to assist the drainage of bile. [11] Also, the pancreatic duct can be cannulated and stents be inserted. The pancreatic duct requires visualisation in cases of pancreatitis.
Self-expandable metallic stents "play an important role in the management of malignant obstructing lesions in the gastrointestinal tract." [2] A stent may be inserted into the common bile duct during an endoscopic retrograde cholangiopancreatography, especially if gallstone removal is deemed too risky. [3]
Some uses for this procedure includes: drainage of bile/infected bile to relieve obstructive jaundice, to place a stent to dilate a stricture in the biliary system, stone removal, and rendezvous technique [4] where guidewire from the common bile duct (CBD) meets with duodenoscope (coming from the oesophagus into the stomach and then duodenum) at the major duodenal papilla.
Choledochoduodenostomy (CDD) is a surgical procedure to create an anastomosis, a surgical connection, between the common bile duct (CBD) and an alternative portion of the duodenum. [1] In healthy individuals, the CBD meets the pancreatic duct at the ampulla of Vater, which drains via the major duodenal papilla to the second part of duodenum. [2]
Expandable mesh stents can be deployed in the oesophagus at endoscopy, primarily in patients with inoperable oesophageal cancer which is causing dysphagia. [18] Plastic stents can also be used to relieve obstruction of the common bile duct at ERCP. [19]
Hypaque or other water-soluble dye may be placed through the passage to ensure patency of the stent on fluoroscopy. [15] Enteric and colonic SEMS are inserted in a similar fashion, but in the duodenum and colon respectively. [16] Biliary SEMS are used to palliatively treat tumours of the pancreas or bile duct that obstruct the common bile duct.
If the jaundice is very high, the surgeon may choose to decrease jaundice before surgery by doing a procedure called endoscopic retrograde cholangiopancreatography (ERCP) and stenting. In this, a plastic or metallic tube (stent) is placed in the bile duct, which is blocked by the tumour, and opens it up from inside.
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