I just wanted to drop you a short note on your patient [Name]. As I know you are well aware, she was seen by my partner, Dr. [Name] for evaluation for bile duct stones, and found to have very large load of stones in the left intrahepatic ducts. She returned to seen me on July 16, for repeat ERCP, at which time with the plan to use SPYGLASS cholangioscopy technology to try to manage these stones. We had provisionally also scheduled her for a PTC tomorrow if our efforts failed.
We perform her ERCP under MAC anesthesia. We 1st removed the pigtail stent that Dr. [Name] left behind into the left intrahepatic system. We then washed the bile duct to remove as much mucus and debris as possible. We then used the SPYGLASS cholangioscope to enter the left …show more content…
We spent considerable time performing lithotripsy on a yellowish stone material. We then used the SPYGLASS directional control (four way) to place the guidewire deeply into the most difficult branch of the left intrahepatic duct. We then swept the balloon through the duct on multiple occasions removing copious amounts of stone, mucus, and debris. We then redirected the balloon into a 2nd large branch of the left intrahepatic system, and again swept it vigorously. I should mention also that during the balloon sweeps with the balloon inflated, we instilled copious amounts of water downstream of the balloon to try to wash the system as well. We completed this maneuver, and then performed a cholangiogram, and much to our surprise, the left intrahepatic duct looked clear but was massively dilated. I think in retrospect, it was filled not only with stones but with mucus, and other material. We then directed our attention to the right intrahepatic ducts, and entered it with the SPYGLASS technology and performed the lithotripsy of stones there as well. I should mention however that the right
We perform her ERCP under MAC anesthesia. We 1st removed the pigtail stent that Dr. [Name] left behind into the left intrahepatic system. We then washed the bile duct to remove as much mucus and debris as possible. We then used the SPYGLASS cholangioscope to enter the left …show more content…
We spent considerable time performing lithotripsy on a yellowish stone material. We then used the SPYGLASS directional control (four way) to place the guidewire deeply into the most difficult branch of the left intrahepatic duct. We then swept the balloon through the duct on multiple occasions removing copious amounts of stone, mucus, and debris. We then redirected the balloon into a 2nd large branch of the left intrahepatic system, and again swept it vigorously. I should mention also that during the balloon sweeps with the balloon inflated, we instilled copious amounts of water downstream of the balloon to try to wash the system as well. We completed this maneuver, and then performed a cholangiogram, and much to our surprise, the left intrahepatic duct looked clear but was massively dilated. I think in retrospect, it was filled not only with stones but with mucus, and other material. We then directed our attention to the right intrahepatic ducts, and entered it with the SPYGLASS technology and performed the lithotripsy of stones there as well. I should mention however that the right