ERCP: Full spectrum from grade 1 intervention for common bile duct stones to grade 4 advanced diagnostic (sphincter of Oddi manometry, peroral cholangioscopy, and pancreas divisum) and post-surgical anatomy with advanced therapeutic interventions.
• Diagnosis and management of benign and malignant bile duct and pancreatic duct strictures related to chronic pancreatitis, including the use of self-expandable metal stents (usually uncovered for malignant) and fully covered for certain types of benign biliary strictures in addition to multiple plastic stents.
Pancreatic Duct Stricture from Chronic Pancreatitis managed endoscopically with balloon dilation and placement of three 7 Fr PD stents.
Clockwise from top left: High grade obstructing and symptomatic PD stricture in chronic pancreatitis; balloon dilation of stricture (note persistent “waist” of balloon); Multiple 7Fr PD stents in parallel across stricture.
Multiple common bile duct stents (11.5 Fr and 10 Fr) and pancreatic duct stents (7 Fr x3) for chronic pancreatitis with pancreatic and bile duct strictures.
Clockwise from top left: Cholangiogram showing high grade obstructing distal CBD stricture from chronic pancreatitis. Secured wire cannulation in PD; Fluoroscopic image of the multiple CBD and PD stents placed after stricture dilation; Endoscopic image after placement multiple CBD and PD stents.
Uncovered self expandable metal stent for malignant stricture of bile duct due to inoperable metastatic pancreatic cancer.
Pancreas divisum and endotherapy for recurrent acute pancreatitis
Spyglass (First Generation- fiber optic catheter) Cholangioscopy and Pancreatoscopy
Cholangiogram of malignant CBD stricture and Spyglass cholangioscopy of cholangiocarcinoma. The bottom middle image is normal appearance of the proximal CBD epithelia at the hilum. Uncovered biliary SEMS (Olympus Medinol) placement.
Spyglass™ (first generation fiberoptic catheter) and Holmium laser lithotripsy of large CBD stones