DAVE Project – Gastroenterology

Serag Dredar, MD, Yale University
Harry Aslanian, M.D., Yale University

Introduction: An 80 yo male was referred for jaundice due to cancer of the pancreatic head resulting in obstruction of the distal common bile duct (CBD). An attempt at ERCP had already been undertaken but failed due to periampullary tumour invasion and ulceration. Informed consent for attempted EUS guided access to the biliary tree was given after [...]

Cetin Karaca, MD, Istanbul University
Bulent Baran, MD, Istanbul University

Cholangioscopy has an increasingly important role in the diagnosis and treatment of biliary and pancreatic diseases. Initiative attempts were made during late 1970s, but due to the technical difficulties the procedure did not find a place in routine endoscopic practice (1,2). Over the past 20 years miniature scopes were designed which pass through [...]

Patrick Yachimski, MD, Vanderbilt University Medical Center

The patient had undergone cholecystectomy for calculous gallbladder disease, followed by ERCP with biliary stent placement. He was referred for endoscopic removal of a proximally migrated biliary stent. Scout film obtained at the time of ERCP showed a 10-French plastic biliary stent predominantly within the left intrahepatic biliary tree. Attemp [...]

Shyam Menon, MRCP, University Hospital Aintree
Richard Sturgess, MD, University Hospital Aintree

An 81-year old male presented to his local hospital with multiple episodes of biliary colic and two episodes of cholangitis. Cross-sectional imaging revealed a 20mm common bile duct stone with dilated extra and intra-hepatic bile ducts. Attempted ERCP failed twice due to the presence of a large duodenal diverticulum. At ERCP, we found a large per [...]

Raymond Tang, MD, University of California San Diego
Thomas Savides, MD, University of California San Diego

A 62 year-old man was referred for recurrent obstructive jaundice. Cross-sectional imaging revealed dilated biliary system without obvious obstructing lesion. ERCP at an outside facility demonstrated filling defects in a markedly dilated common bile duct. Bile duct balloon sweeps removed large amount of gelatinous and purulent material but no sto [...]

Shyam Menon, MRCP, University Hospital Aintree
Richard Sturgess, MD, University Hospital Aintree

A 91-year old woman was admitted with painless jaundice, weight loss and Cholestatic symptoms. Imaging revealed dilated intra and extra-hepatic bile ducts down to the level of the ampulla. We were unable to initially obtain selective deep cannulation of the bile duct using a sphincterotome and wire in a standard technique as the ampulla was very fl [...]

Shyam Menon, MRCP, University Hospital Aintree
Monica Terlizzo, MD, University Hospital Aintree
Richard Sturgess, MD, University Hospital Aintree

A 68-year old man was admitted with weight loss, deep jaundice and Cholestatic liver function tests (LFTs). Cross-sectional imaging revealed dilatation of the intrahepatic ducts. Close inspection revealed a sharp cut-off at the level of the hilum suggestive of a hilar infiltrative process. Moreover, the intrahepatic ducts were not significantly dil [...]

Shahzad Iqbal, MD, Columbia University Medical Center
Peter D. Stevens, MD, Columbia University Medical Center

This is a 59 years old patient who was recently diagnosed with pancreatic adenocarcinoma metastatic to the liver. MRCP showed bilateral intrahepatic biliary dilation with abrupt central termination (these findings were compatible with Bismuth IV tumor). He underwent PTCA with right liver external-internal drain placement, and ERCP with left liver p [...]

Manmeet Padda, MD, Yale University
Harry Aslanian, M.D., Yale University

An 84 year old male with history of melanoma of the scalp diagnosed two years prior, was found to have a splenic lesion on abdominal CT scan. CT scan showed a round, hypoechoic lesion in the spleen as shown by the arrow. Linear EUS examination identified a 2 cm round, hypoechoic, hypovascular and heterogeneous lesion in the spleen as shown by the [...]

Kapil Gupta, M.D., Hennepin County Medical Center, University of Minnesota

In this video we will describe a novel technique of EUS guided choledochoduodenostomy as a 1-step procedure using a echoendoscope. We perform this procedure in patients with unresectable malignancy causing obstructive jaundice. In patients where standard ERCP or EUS guided rendezvous has failed or is not an option. A detailed discussion with th [...]