Pancreatic Sphincterotomy and Stent Placement for a Communicating Pseudocyst
Comments: ERCP is attempted for transpapillary drainage of a communicating pseudocyst. Cannulation of the pancreatic orifice is performed using a standard sphincterotome. Injection pancreatogram reveals a gush of contrast extravasating from the main pancreatic duct. A large amount of contrast is seen pooling behind the endoscope. A decision is made to perform a pancreatic sphincterotomy and place a pancreatic duct stent. Using a guidewire technique, the sphincterotome cutting wire is positioned in the 12 o'clock to 1 o'clock position to cut the pancreatic portion of the sphincter of Oddi. In order to expose more of the intraduodenal portion of the sphincter muscle, the sphincterotome is contracted, or bowed, within the proximal pancreatic duct while simultaneously withdrawing the instrument to pull the sphincter out from the duodenal wall. In doing so, more of the pancreatic sphincter can be splayed to achieve a larger sphincterotomy. After sphincterotomy, the sphincterotome is exchanged over the guidewire. A 5-French, 3 cm pancreatic duct stent is placed to facilitate drainage of cyst fluid out the pancreatic duct orifice.
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Jonathan M Buscaglia, MD Instructor of Medicine Johns Hopkins Medical Center Anthony Kalloo, M.D. Chief of Gastroenterology Johns Hopkins Medical Center |
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Citation: Buscaglia, JM & Kalloo, A. (Nov 20 2009). Pancreatic Sphincterotomy and Stent Placement for a Communicating Pseudocyst. The DAVE Project. Retrieved Feb, 8, 2010, from http://daveproject.org/viewfilms.cfm?film_id=885 Times viewed since Feb 2006: 880 |
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