Loading...

Endoscopy Master Videos: ERCP metal stent in a metal stent @ www.gastroliver.com.sg

7,000 views

Loading...

Loading...

Loading...

Rating is available when the video has been rented.
This feature is not available right now. Please try again later.
Published on Dec 19, 2010

This video demonstrates an almost impossible ERCP to salvage a patient with advanced pancreatic cancer. He survived 18 months with gemcitabine chemotherapy. One month after insertion of a metal stent and surgical gastrojejunostomy, the tumor had rapidly ingrown and overgrown the stent, obscuring it completely in the duodenum. He had severe sepsis and cardiac arrest from ventricular fibrillation due to acidosis, hypokalemia and hypotension. He was resuscitated and urgent ERCP was performed to insert a covered metal stent within the lumen and through the mesh of the previous uncovered metal stent. Technically the challenges were 4 fold: (1) intubated patient on assisted ventilation in the supine position, (2) accessing the area after a gastrojejunostomy in the "long" position, (3) locating and cannulating the metal stent with fluoroscopy guidance, using trial and error, with the papilla in the unfavourable 6 o'clock position, (4) insertion, deployment of the covered metal stent which has a stiff delivery system and overcoming U-shape knuckling of the system in the duodenum - performed under challenging conditions of limited maneuvrability and visibility. Recurrent cholangitis remains the Achilles heel of endoscopic biliary drainage since its inception almost 20 years ago. ERCP biliary stenting is a good treatment for patients with a "bad prognosis" and short survival. It is not such a good treatment for patients with a "good prognosis" who survive more than 6 months because it means more ERCP procedures to manage stent occlusion. In this era of improved chemotherapy and better survival, patients now have an intermediate prognosis and live longer. Perhaps it is time to re-visit the issue of surgical bypass (hepatico-jejunostomy +/- gastro-jejunostomy) prior to starting chemotherapy for a better quality of life. A head-to-head trial comparing surgical bypass with ERCP covered metal stent in the setting of chemotherapy could help resolve this issue.

Loading...

When autoplay is enabled, a suggested video will automatically play next.

Up next


to add this to Watch Later

Add to

Loading playlists...