Large Diameter Balloon Dilation for Removal of Bile Duct Stone
Comments: 83 year old male with multiple co-morbidities presented with fever, abnormal liver enzymes and dilated common bile duct (CBD) up to 15 mm in size on abdominal CT scan and elevated international normalized ratio (INR). A pull type sphincterotome was used to cannulate the common bile duct. After the slight adjustment, the sphincterotome was advanced freely without any resistance into the common bile duct and the cholangiogram was obtained.
Here we see a large common bile duct stone on the cholangiogram. This stone was approximately 15 mm in size. A small biliary sphincterotomy was performed using the endocut current. We used controlled radial expansion (CRE) balloon over the guidewire to dilate the biliary orifice. We inflated the CRE balloon up to 12 mm and was kept in position for approximately 30 seconds. The cholangiogram is showing the gradual expansion of the CRE balloon in the common bile duct. Then the balloon was inflated up to 15 mm and was kept in position for another 30 seconds. This view shows the inflated CRE balloon up to 15 mm. Slight capillary oozing was seen at the site of biliary sphincteroplasty. This was most likely due to elevated INR of the patient. A mechanical lithotripsy basket was used to remove the CBD stones. This cholangiogram shows two CBD stones within the lithotripsy basket. These CBD stones were removed without any difficulty from the common bile duct.
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Manmeet Padda, MD Advanced Endoscopy Fellow Yale University Uzma Siddiqui, M.D. Assistant Professor of Medicine Yale University Harry Aslanian, M.D. Associate Professor of Medicine Yale University Priya A. Jamidar, MD Professor of Medicine, Director of Endoscopy Yale University |
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Citation: Padda, M. & Siddiqui, U. & Aslanian, H. & Jamidar, PA (Nov 20 2009). Large Diameter Balloon Dilation for Removal of Bile Duct Stone. The DAVE Project. Retrieved Feb, 9, 2010, from http://daveproject.org/viewfilms.cfm?film_id=887 Times viewed since Feb 2006: 2437 |
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