- 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.