Endoscopic retrograde cholangiopancreatography, sphincterotomy, and removal of bile duct stone

PROCEDURE:

1.  Upper endoscopy.

2.  Endoscopic retrograde cholangiopancreatography, sphincterotomy, and removal of bile duct stone.

The indication, risks, benefits, alternatives, and limitations were explained to the patient and husband yesterday in the office and again today at the bedside to the patient.

INDICATIONS:  Possible common bile stone, possible bile leak, abdominal pain, rule out upper GI causes, and abnormal LFTs.

The indication, risks, benefits, alternatives, and limitations were explained to the patient and her husband.  The risk of anesthesia, perforation, bleeding, infection, cardiopulmonary risk, morbidity, and mortality were discussed.  Possibility of missing a lesion, a polyp, a growth, a mass, or cancer was discussed.  The risk of cold biopsy, hot biopsy, and polypectomy was discussed.  The risk of oropharyngeal injury, sore throat, bronchitis, aspiration, aspiration pneumonia, and sinusitis were discussed.  Esophageal and pharyngeal injury and perforation discussed.  Duodenal injury and perforation discussed.  The risk of sphincterotomy, bleeding, perforation, and need for surgery discussed.  The risks of bile duct injury, bile duct leak were discussed.  The risks of mild-to-severe pancreatitis, consequences of pancreatitis, morbidity, and mortality were discussed.  The risks of cholangitis were discussed.  The need for antibiotics was discussed.  All these discussions were explained in detail yesterday, they both understood everything.  Today, I explained everything to the patient again, she understood everything and she gave an informed consent both for the endoscopy and for the ERCP.

PROCEDURE IN DETAIL:  She was then brought to the Radiology suite.  Anesthesia of the intubated and anesthetized the patient and the endoscopy was first procedure.  The gastroscope was advanced into the esophagus, stomach, and duodenum.  Third portion, and second portion bulb was normal.  Pylorus was normal.  Antrum was normal.  On retroflexion, lesser curvature, greater curvature, fundus, and cardia were normal.  The stomach insufflated very well.  No abnormal folds were seen.  Esophagogastric junction was normal.  Esophageal mucosa was normal.  Procedure completed.  The patient tolerated procedure well.

Next procedure ERCP, the ERCP scope was advanced into the esophagus, stomach, and duodenum.  Ampulla was identified.  Using a wire only the bile duct was easily cannulated.  Cholangiogram showed common bile stone confirmed by Dr. Michael Katz, radiologist present in the room.  Following which, a sphincterotomy was done safely without any complications.  Following which without any difficulty using a balloon, the stone was removed.  Following this, an occlusion final cholangiogram was done, bile duct was clear and the bile duct drained very quickly and very well.  Procedure completed. The patient tolerated the procedure well