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Bruno MEDURI

Hôpital Privé des Peupliers
Paris, France
MD
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Diagnosis and treatment of symptomatic common bile duct stones following cholecystectomy by means of EUS and ERCP
A post-cholecystectomy syndrome is a well-known condition, which includes dyspepsia and biliary-like abdominal pain coupled with deterioration of liver enzymes. Biliary factors responsible for a post-cholecystectomy syndrome could be the following: biliary iatrogenic duct strictures, retained stones in the common bile duct (CBD), cystic stump, or even a gallbladder remnant.
The diagnosis of stones is difficult to establish considering that even trans-abdominal ultrasonography has a diagnostic sensitivity of only 27%. Conversely, endoscopic ultrasound (EUS) is a very useful tool to diagnose stones in such situations, allowing to perform subsequent ERCP and stone extraction during the same anesthetic session. Here, we report the case of a 69-year-old man who underwent laparoscopic cholecystectomy and who was referred to us after 24 hours of abdominal colic pain and cholestasis. He underwent EUS, which diagnosed residual common bile duct stones. As a result, treatment was performed by means of ERCP during the same session.
Surgical intervention
4 years ago
1450 views
62 likes
0 comments
03:26
Diagnosis and treatment of symptomatic common bile duct stones following cholecystectomy by means of EUS and ERCP
A post-cholecystectomy syndrome is a well-known condition, which includes dyspepsia and biliary-like abdominal pain coupled with deterioration of liver enzymes. Biliary factors responsible for a post-cholecystectomy syndrome could be the following: biliary iatrogenic duct strictures, retained stones in the common bile duct (CBD), cystic stump, or even a gallbladder remnant.
The diagnosis of stones is difficult to establish considering that even trans-abdominal ultrasonography has a diagnostic sensitivity of only 27%. Conversely, endoscopic ultrasound (EUS) is a very useful tool to diagnose stones in such situations, allowing to perform subsequent ERCP and stone extraction during the same anesthetic session. Here, we report the case of a 69-year-old man who underwent laparoscopic cholecystectomy and who was referred to us after 24 hours of abdominal colic pain and cholestasis. He underwent EUS, which diagnosed residual common bile duct stones. As a result, treatment was performed by means of ERCP during the same session.
Endoscopic biliary stones extraction using a forward viewing standard gastroscope in a patient with altered anatomy (partial gastrectomy with Billroth II reconstruction)
Endoscopic retrograde cholangiography in case of altered anatomy such as partial gastrectomy with Billroth II reconstruction has a success rate of 85% due to different factors such as failure to cross the anastomosis and the presence of an important length of afferent loop with a high risk of jejunal perforation at (or near) the anastomotic site while advancing the duodenoscope. The use of a front-view scope is the safest and could be used theoretically. However, the lack of elevator, the inability to see the papilla in a direct view, and the limited number of catheters available for cannulation and therapeutic procedures in the standard gastroscope with the 2.8mm working channel, can make this kind of procedure quite challenging. In this video, we present a case of successful biliary stone extraction in a patient with Billroth II reconstruction using a standard 2.8mm working channel front-viewing scope.
Surgical intervention
4 years ago
869 views
14 likes
0 comments
04:47
Endoscopic biliary stones extraction using a forward viewing standard gastroscope in a patient with altered anatomy (partial gastrectomy with Billroth II reconstruction)
Endoscopic retrograde cholangiography in case of altered anatomy such as partial gastrectomy with Billroth II reconstruction has a success rate of 85% due to different factors such as failure to cross the anastomosis and the presence of an important length of afferent loop with a high risk of jejunal perforation at (or near) the anastomotic site while advancing the duodenoscope. The use of a front-view scope is the safest and could be used theoretically. However, the lack of elevator, the inability to see the papilla in a direct view, and the limited number of catheters available for cannulation and therapeutic procedures in the standard gastroscope with the 2.8mm working channel, can make this kind of procedure quite challenging. In this video, we present a case of successful biliary stone extraction in a patient with Billroth II reconstruction using a standard 2.8mm working channel front-viewing scope.
Single stage diagnosis and treatment by EUS and ERCP of a pancreatic stone causing an acute pancreatitis
Biliopancreatic stones are the ‘primum movens’ of acute pancreatitis. Pure pancreatic stones are rare. However, when present, they are the main cause of acute obstruction of the main pancreatic duct. Conversely, when present in chronic pancreatitis, they are mostly responsible for pancreatic glandular insufficiency. Medical treatment, radiologic evaluation (by MRI or CT-scan), and therapeutic endoscopy constitute the standard of care (SOC).
Here, we report the case of a 25-year-old man, admitted for upper middle abdominal pain and hyperamylasemia, without anomalies in liver function tests, and who underwent biliopancreatic EUS. A pancreatic stone was diagnosed and immediately treated by endoscopic pancreatic sphincterotomy and extraction.
Surgical intervention
4 years ago
1160 views
41 likes
0 comments
05:10
Single stage diagnosis and treatment by EUS and ERCP of a pancreatic stone causing an acute pancreatitis
Biliopancreatic stones are the ‘primum movens’ of acute pancreatitis. Pure pancreatic stones are rare. However, when present, they are the main cause of acute obstruction of the main pancreatic duct. Conversely, when present in chronic pancreatitis, they are mostly responsible for pancreatic glandular insufficiency. Medical treatment, radiologic evaluation (by MRI or CT-scan), and therapeutic endoscopy constitute the standard of care (SOC).
Here, we report the case of a 25-year-old man, admitted for upper middle abdominal pain and hyperamylasemia, without anomalies in liver function tests, and who underwent biliopancreatic EUS. A pancreatic stone was diagnosed and immediately treated by endoscopic pancreatic sphincterotomy and extraction.
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.
Surgical intervention
4 years ago
885 views
13 likes
0 comments
04:09
Endoscopic extraction of a giant cystic duct stone to treat type I Mirizzi syndrome
Mirizzi syndrome (MS) is characterized by common hepatic duct obstruction due to mechanical compression and surrounding inflammation by a gallstone impacted in the cystic duct (type I) or at the gallbladder neck (type II). Preoperative diagnosis of the syndrome is mandatory and associated with a decrease of complication rate of surgical management. Endoscopic therapies like ERCP with lithotripsy or endoscopic extraction of cystic duct calculi followed by laparoscopic cholecystectomy have been described. Here we report successful endoscopic stone-clearance using double-cannulation and large balloon dilatation of the papilla for giant biliary stone impacted in the cystic duct inserted low in the common hepatic duct causing type I MS.
Bibliographic reference:
Double-cannulation and large papillary balloon dilation: key to successful endoscopic treatment of mirizzi syndrome in low insertion of cystic duct. Donatelli G, Dhumane P, Dallemagne B, Marx L, Delvaux M, Gay G, Marescaux J. Dig Endosc 2012;24:466-9.