Endoscopic retrograde cholangiopancreatography, sphincterotomy, and stone extraction with balloon

PROCEDURES PERFORMED:               Endoscopic retrograde cholangiopancreatography, sphincterotomy, and stone extraction with balloon.

MEDICATIONS:                                           Per Anesthesia.

PROCEDURE IN DETAIL:                                    The risks of perforation, bleeding, infection, and sedation were outlined.  The patient is aware of the risk of pancreatitis and perforation.  Medicated with intubation per Anesthesia.  Once in the prone position with head off to the left side, the scope was advanced easily into the second portion of the duodenum.  Once the major ampulla was identified and appeared to be normal with some bile coming out of it, the Hydratome was utilized to try selectively cannulate the common bile duct and initial cannulation despite going in the right direction resulted in pancreatic cannulation.  This was evident by the wire position.  This was readjusted and then appeared to be in the bile duct position.  Brief cholangiography attempt resulted in pancreatography.  Then, manipulation of the angle of the sphincterotome was utilized to selectively cannulate the common bile duct, which identified four filling defects within the distal common bile duct compatible with stones.  These were extracted off the sphincterotomy with 9-to 12-mm balloon.  All the stones were seen coming out except cholangiography only revealed bubbles.  The gallbladder did not fill.  There was good bile drainage at the completion of the procedure.  The patient will be observed today with cholecystectomy, to follow up with Surgery, should be kept on antibiotics and fluids, n.p.o. until pain free.  The liver enzymes to be obtained in the a.m.