Biloma drainage using endoscopic ultrasound guided stent placement скачать в хорошем качестве

Biloma drainage using endoscopic ultrasound guided stent placement

Watch as Dr. Joseph K Kim walks you through a biloma drainage procedure and explains each detail and step along the way. Dr. Joseph Kim is dual Board-certified in Internal Medicine and Gastroenterology. TRANSCRIPT: This is a clinical presentation of a young woman who underwent an elective cholecystectomy which is removal of her gallbladder for abdominal pain? Unfortunately, she suffered a complication where there was a leak of her common bile duct the common bile duct was stented with a fully covered metal with soft fully covered biliary stent metal stents. However, she developed a a leakage of her bowel duct and developed what we call a biloma. Which is a collection of bile around that area where it leaks around and she was having persistent abdominal pain. The goal of this procedure was to perform a discovery ultrasound guided access into this biloma followed by placement of a wire into it followed by placement of two stents that would be going from the stomach into the biloma to drain this biloma internally this is all endoscopic without the need for any surgeries and now I'm starting the video this is the pilot drainage video this part shows the measurements for the biloma which is the fluid collection of file and this is endoscopic ultrasound I'm using an instructor ultrasound to identify this collection then in the top you see the needle poking through it Through the stomach Wall into the biloma and that bright white light is there? Now on the endoscopic view we see the wire that's going through the stomach wall Into the biloma and I'm using an eel knife to cut a hole From the stomach into this biloma This is an X-Ray image of the endoscope Showing the wire into stomach and also into the biloma and now I'm going through it with my catheter Traversing the gastric gloaming is going through the stomach wall with the catheter Just to access it and make a fistula. Which is a connection that we are making We're putting contrasts into the biloma to that dark black area of contrast that is filling this biloma that we are injecting through the catheters through the endoscope from the stomach wall and Once we confirm that placement. We are deploying a Fully covered metal stent this metal stent It is made out of night melt is covered So that there can be no in Growth of tissue and we're deploying this using fluoroscopic which is x-Ray imaging along with the endoscopic view which you see in the left lower quadrant and this is successful deployment and once it's deployed you see that there is a flash of file that comes out and That successful placement there, and you can see the stent It kind of looks like an hourglass shape One part of the stent is sticking out into the stomach women the other stent Other part of the extent is going into the biloma. This is the wire going through the stents and The reason I'm putting the wire and do this vent here. Is that I can place another plastic stent through the net extent that's going to take tale, so it anchors this metal stent So it doesn't go out of the stomach or it doesn't fall into the stomach so that's what it looks like if you see that blue stands within the metal stents and That's the end of the case this patient did great post procedure lee instead of requiring surgical intervention She was able to be fixed Andis Copic Lee and after about four to six weeks. We removed all the stents. She owes asympTomatic and Everything healed on its own without the need for any surgery For more information please visit: http://www.DigestiveCAREDFW.com