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Ivo BOŠKOSKI

Gastroenterology & Digestive Endoscopy Fondazione Policlinico Gemelli
Rome, Италия
MD, PhD
460 лайков
6.6K просмотров
2 комментария
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All you need to know to perform an ERCP for biliary stones extraction: live procedure
An 82-year-old man underwent an emergency endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis secondary to choledocholithiasis 11 days earlier. At that time, since the patient was under Clopidogrel, the sphincterotomy was not performed and a plastic stent was released in the common bile duct (CBD) to bypass the stones. In this live procedure, Dr. Boškoski performs an ERCP with sphincterotomy and biliary stones extraction. During the procedure, the operator gives every fundamental tips and tricks to perform the correct procedure. At the end of the intervention, a 3D cholangiography is performed to confirm complete biliary stones extraction.
Хирургические операции
3 месяца назад
678 просмотров
12 лайков
1 комментарий
35:21
All you need to know to perform an ERCP for biliary stones extraction: live procedure
An 82-year-old man underwent an emergency endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis secondary to choledocholithiasis 11 days earlier. At that time, since the patient was under Clopidogrel, the sphincterotomy was not performed and a plastic stent was released in the common bile duct (CBD) to bypass the stones. In this live procedure, Dr. Boškoski performs an ERCP with sphincterotomy and biliary stones extraction. During the procedure, the operator gives every fundamental tips and tricks to perform the correct procedure. At the end of the intervention, a 3D cholangiography is performed to confirm complete biliary stones extraction.
Anastomotic biliary stricture after liver transplantation
Biliary stricture is the most frequent complication after liver transplantation, and ranges from 5 to 32%. Biliary strictures in transplanted patients can be anastomotic and non-anastomotic. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the first-line treatment modality for anastomotic biliary strictures and in selected cases of non-anastomotic biliary strictures. Anastomotic biliary strictures arise at the site of the choledocho-choledochostomy. ERCP with multiple plastic stent placements is the first-line treatment of anastomotic biliary strictures, with long-term success rates ranging from 90 to 100%. Also covered self-expandable metal stents can be used for dilation of these strictures, but not routinely.
Хирургические операции
2 года назад
1573 просмотра
68 лайков
0 комментариев
09:31
Anastomotic biliary stricture after liver transplantation
Biliary stricture is the most frequent complication after liver transplantation, and ranges from 5 to 32%. Biliary strictures in transplanted patients can be anastomotic and non-anastomotic. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the first-line treatment modality for anastomotic biliary strictures and in selected cases of non-anastomotic biliary strictures. Anastomotic biliary strictures arise at the site of the choledocho-choledochostomy. ERCP with multiple plastic stent placements is the first-line treatment of anastomotic biliary strictures, with long-term success rates ranging from 90 to 100%. Also covered self-expandable metal stents can be used for dilation of these strictures, but not routinely.
Postoperative CBD stenosis
Benign biliary strictures are often a consequence of iatrogenic injury during laparoscopic cholecystectomy or they may arise after liver transplantation or hepatic resection with duct-to-duct biliary anastomosis. Other etiologies of benign biliary strictures are primary sclerosing cholangitis, chronic pancreatitis, and autoimmune cholangitis. In the past, surgical repair was the treatment of choice. Today, ERCP has a pivotal role in the treatment of the vast majority of these lesions. Up to 80% of postoperative benign biliary strictures develop within 6 to 12 months after surgery with symptoms as pruritus, jaundice, abdominal pain, alterations of liver function tests and recurrent cholangitis. Prompt identification of these lesions is essential because long-standing cholestasis can lead to secondary biliary cirrhosis. MRCP with cholangiographic sequences is the preferred non-invasive method for diagnostic cholangiography. In particular, this imaging method can be useful in hilar strictures and in patients with suspected anastomotic biliary stricture after liver transplantation.
Хирургические операции
2 года назад
1095 просмотров
66 лайков
0 комментариев
11:04
Postoperative CBD stenosis
Benign biliary strictures are often a consequence of iatrogenic injury during laparoscopic cholecystectomy or they may arise after liver transplantation or hepatic resection with duct-to-duct biliary anastomosis. Other etiologies of benign biliary strictures are primary sclerosing cholangitis, chronic pancreatitis, and autoimmune cholangitis. In the past, surgical repair was the treatment of choice. Today, ERCP has a pivotal role in the treatment of the vast majority of these lesions. Up to 80% of postoperative benign biliary strictures develop within 6 to 12 months after surgery with symptoms as pruritus, jaundice, abdominal pain, alterations of liver function tests and recurrent cholangitis. Prompt identification of these lesions is essential because long-standing cholestasis can lead to secondary biliary cirrhosis. MRCP with cholangiographic sequences is the preferred non-invasive method for diagnostic cholangiography. In particular, this imaging method can be useful in hilar strictures and in patients with suspected anastomotic biliary stricture after liver transplantation.
Common bile duct stricture due to an inoperable pancreatic head cancer: metal stent placement
There are several major indications for the endoscopic drainage of malignant common bile duct obstruction. There are several types of drainage: a preoperative biliary drainage, which is performed in selected cases (delayed surgery, high bilirubin levels, itching, cholangitis), a biliary drainage before neo-adjuvant therapies, and a biliary drainage for palliation. According to the ESGE guidelines, palliative biliary drainage should be performed according to life expectancy. If less than 4 months, plastic stent placement is recommended; if longer than 4 months, a self-expandable metal stent should be placed. In any case, every single patient should be evaluated for the best treatment. In particular, since uncovered self-expandable metal stents are impossible to remove, malignancy must be evidenced before placement of these stents.
Хирургические операции
2 года назад
909 просмотров
83 лайка
0 комментариев
18:14
Common bile duct stricture due to an inoperable pancreatic head cancer: metal stent placement
There are several major indications for the endoscopic drainage of malignant common bile duct obstruction. There are several types of drainage: a preoperative biliary drainage, which is performed in selected cases (delayed surgery, high bilirubin levels, itching, cholangitis), a biliary drainage before neo-adjuvant therapies, and a biliary drainage for palliation. According to the ESGE guidelines, palliative biliary drainage should be performed according to life expectancy. If less than 4 months, plastic stent placement is recommended; if longer than 4 months, a self-expandable metal stent should be placed. In any case, every single patient should be evaluated for the best treatment. In particular, since uncovered self-expandable metal stents are impossible to remove, malignancy must be evidenced before placement of these stents.
ERCP: acute cholangitis in a patient with antiplatelet (clopidogrel) therapy
Acute cholangitis is a clinical emergency. Urgent biliary drainage and bile ducts disobstruction represent the only effective therapy. Acute cholangitis is a result of bile flow obstruction and bile infection. Both ERCP and percutaneous biliary drainage are valid therapeutic options associated with antibiotics. ERCP with biliary sphincterotomy and stones clearance is less invasive and generates less discomfort as compared to percutaneous biliary drainage. Percutaneous biliary drainage is reserved for patients in poor or bad clinical conditions and co-morbidities, unavailability of ERCP or surgically altered anatomy unsuitable for ERCP. We present a case of an 81-year-old female patient with antiplatelet therapy (Plavix®/clopidogrel) and cholangitis. During ERCP, there was evidence of previously unreported small biliary sphincterotomy. Consequently, biliary balloon dilation followed by stones extraction were performed. A nasobiliary drainage was also placed to flush the bile ducts with saline over 24 hours.
Хирургические операции
2 года назад
552 просмотра
93 лайка
1 комментарий
09:17
ERCP: acute cholangitis in a patient with antiplatelet (clopidogrel) therapy
Acute cholangitis is a clinical emergency. Urgent biliary drainage and bile ducts disobstruction represent the only effective therapy. Acute cholangitis is a result of bile flow obstruction and bile infection. Both ERCP and percutaneous biliary drainage are valid therapeutic options associated with antibiotics. ERCP with biliary sphincterotomy and stones clearance is less invasive and generates less discomfort as compared to percutaneous biliary drainage. Percutaneous biliary drainage is reserved for patients in poor or bad clinical conditions and co-morbidities, unavailability of ERCP or surgically altered anatomy unsuitable for ERCP. We present a case of an 81-year-old female patient with antiplatelet therapy (Plavix®/clopidogrel) and cholangitis. During ERCP, there was evidence of previously unreported small biliary sphincterotomy. Consequently, biliary balloon dilation followed by stones extraction were performed. A nasobiliary drainage was also placed to flush the bile ducts with saline over 24 hours.
Removal of large biliary stones
Biliary stones can be easy or difficult to remove, depending on their dimensions. Understanding bile ducts anatomy, choosing the appropriate devices/extraction technique, developing confidence with biliary lithotripsy, choosing the appropriate size of the sphincterotomy, performing large balloon biliary dilation in appropriate cases and management of failed stones extraction are the basic key issues in the management of biliary stones. Here, we present the case of a 96-year-old female patient who had an episode of cholangitis one week ago and ERCP was performed with a biliary precut to access the bile duct. Since the biliary stones were large, a biliary plastic stent was placed and after unintentional pancreatic duct cannulation, a pancreatic stent was also placed to prevent pancreatitis. ERCP was repeated. The biliary stent was removed since the stones were approximately 12mm in diameter. A biliary balloon dilation was carried out to facilitate the removal. At the end, the pancreatic stent was also removed.
Хирургические операции
2 года назад
1115 просмотров
84 лайка
0 комментариев
12:52
Removal of large biliary stones
Biliary stones can be easy or difficult to remove, depending on their dimensions. Understanding bile ducts anatomy, choosing the appropriate devices/extraction technique, developing confidence with biliary lithotripsy, choosing the appropriate size of the sphincterotomy, performing large balloon biliary dilation in appropriate cases and management of failed stones extraction are the basic key issues in the management of biliary stones. Here, we present the case of a 96-year-old female patient who had an episode of cholangitis one week ago and ERCP was performed with a biliary precut to access the bile duct. Since the biliary stones were large, a biliary plastic stent was placed and after unintentional pancreatic duct cannulation, a pancreatic stent was also placed to prevent pancreatitis. ERCP was repeated. The biliary stent was removed since the stones were approximately 12mm in diameter. A biliary balloon dilation was carried out to facilitate the removal. At the end, the pancreatic stent was also removed.
Double wire biliary cannulation, biliary stone removal and pancreatic stent placement
Endoscopic retrograde cholangiopancreatography (ERCP) is the most technically challenging procedure in digestive endoscopy. Cannulation in ERCP requires optimal training, understanding of papillary anatomy, and especially understanding cholangiography and pancreatography imaging. The choice of cannulation technique (contrast vs. wire) depends on the expertise of local teams, even if the injection of a small amount of contrast can better show the way and direction of the ducts. It is essential to choose the appropriate accessories according to the case that's being dealt with. Here, we present the case of a hemophilic 71-year-old male patient with elevated liver enzymes, and magnetic resonance cholangiopancreatography (MRCP) was performed to detect common bile duct stones. The patient has also a left lobe liver hematoma which originated from mild trauma. Endoscopically, the papilla of this patient presented with an ectropion and long infundibulum. Biliary cannulation was performed with the double wire technique, first cannulating Wirsung’s duct which straightened the siphon. After a large biliary sphincterotomy, the stone was removed with a Dormia basket. A small pancreatic stent was placed to prevent pancreatitis.
Хирургические операции
2 года назад
723 просмотра
54 лайка
0 комментариев
18:35
Double wire biliary cannulation, biliary stone removal and pancreatic stent placement
Endoscopic retrograde cholangiopancreatography (ERCP) is the most technically challenging procedure in digestive endoscopy. Cannulation in ERCP requires optimal training, understanding of papillary anatomy, and especially understanding cholangiography and pancreatography imaging. The choice of cannulation technique (contrast vs. wire) depends on the expertise of local teams, even if the injection of a small amount of contrast can better show the way and direction of the ducts. It is essential to choose the appropriate accessories according to the case that's being dealt with. Here, we present the case of a hemophilic 71-year-old male patient with elevated liver enzymes, and magnetic resonance cholangiopancreatography (MRCP) was performed to detect common bile duct stones. The patient has also a left lobe liver hematoma which originated from mild trauma. Endoscopically, the papilla of this patient presented with an ectropion and long infundibulum. Biliary cannulation was performed with the double wire technique, first cannulating Wirsung’s duct which straightened the siphon. After a large biliary sphincterotomy, the stone was removed with a Dormia basket. A small pancreatic stent was placed to prevent pancreatitis.