A 72 year old gentleman with jaundice related to a narrowing in the bile duct and obstructing stone in the bile duct and cystic duct.
To visualise this narrowing cholangio-pancreatoscopy was performed.
Systems available for cholangio-pancreatoscopy include endoscope-based systems, commonly referred to as “mother-daughter systems. There is also a catheter-based system (SpyGlass). In addition, cholangio-pancreatoscopy can be performed using a slim gastroscope in patients with a dilated common bile duct.
The patient underwent SpyGlass direct visualisation of the bile duct which suggested pre-cancerous changes in the bile duct stricture and allowed for blasting of the stones.
Stones can be blasted either using Eletrohydraulic Lithotripsy (EHL), or pulsed laser lithotripsy. Both methods involve passing a fine fibre down the endoscope which can deliver the electrical or laser impulses.
A temporary biliary stent was placed which relieved.
Biliary stents are commonly used in patient with primary pancreaticobiliary malignancy, metastatic disease, and external biliary compression by lymph nodes.
By providing biliary decompression they can relieve jaundice and pruritus, while minimising the risk of developing cholangitis.
