Deep cannulation of the desired channel (biliary or pancreatic) is the basic requirement to successfully perform a therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In biliary cannulation, we have a broad armamentarium of standard and specialized techniques. However, failure rates can range from 1-10%. The consequences of failure in cannulation are serious: repetition of the ER...

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation...

An 88-year-old female with a previous history of retinopathy requiring treatment with Adiro® (acetylsalicylic acid) presented with jaundice, pruritus and right upper quadrant pain. An abdominal ultrasound revealed multiple stones in the common bile duct (CBD). Adiro® was stopped five days before ERCP. ERCP confirmed the presence of multiple stones in the CBD, which were extracted after performi...

During the 5 year period to May 1988, 137 consecutive patients (age range, 65-102 years; median 84 years) with a diagnosis of choledocholithiasis, were referred to The Middlesex Hospital Geriatric Department. Endoscopic sphincterotomy was successful in 96.2% of cases and immediate biliary drainage was achieved in all but one ofthese patients. Stones were cleared endoscopically in 73.3% and surg...

out, should give a better evaluation of its diagnostic and therapeutic value in patients who are to undergo biliary surgery. (1987) Prospective randomised study of pre-operastive endoscopic sphincterotomy versus surgery alone for common bile duct stones. (1987) Study of common bile duct exploration and endoscopic sphincterotomy in a consecutive series of 438 patients. (1988) Surgical versus end...

Endoscopic sphincterotomy was undertaken in 186 patients with common bile duct stones and an intact gall bladder who were considered unfit for surgery. One hundred and seventy one patients had jaundice of whom 18 also had clinical cholangitis. The mean age of treated patients was 79.7 years (range 27-92) and only 13 were aged less than 60. Sphincterotomy was successful in 185 (99%) and complete...

Iatrogenic duodenal perforation associated with endoscopic retrograde cholangiopancreatography (ERCP) is a very uncommon complication that is often lethal. Perforations during ERCP are caused by endoscopic sphincterotomy, placement of biliary or duodenal stents, guidewire-related causes, and endoscopy itself. In particular, perforation of the medial or lateral duodenal wall usually requires pro...

Common bile duct (CBD) stones extraction is usually performed by endoscopic sphincterotomy followed by removal by either a Dormia basket or extraction balloon catheter. However, some stones due to their size are not amenable to these procedures and extracorporeal or mechanical lithotripsy devices need to be used. Mechanical lithotripsy involves usage of a basket that will be inevitably destroye...

Duodenoscopic sphincterotomy is an established method for dealing with common bile duct stones and papillary stenosis. Occasionally even an experienced operator is unable to carry out a sphincterotomy, for instance in the presence of large peri-papillary diverticula or Billroth II gastrectomy. Most of these patients will be offered surgery--a few will refuse or be unfit for operation. One furth...