内镜逆行胰胆管造影short-nosed预扩张辅助取石

                               
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A 70 year old lady presented 6 years ago with jaundice and abdominal pain. At that time, two attempts at ERCP failed because the papilla was within a diverticulum and biliary cannulation was not possible. She therefore had an open cholecystectomy and bile duct exploration. She remained well post operation but has now developed abdominal pain and MRCP shows several large recurrent CBD stones. Another attempt at ERCP has failed for the same reason as before but the surgeons have referred her back for a FOURTH “last ditch" attempt (!) before considering another round of surgery.

The video shows the latest ERCP and DASE (Dilatation Assisted Stone Extraction). It was a case of fourth time lucky.... biliary cannulation was difficult and only possible after a precut with a short-nosed sphincterotome. The subsequent sphincterotomy was necessarily small and was followed by a balloon sphincteroplasty prior to stone extraction.