Stone Extraction, Stricture Dilation, Stenting

Bile and pancreatic duct obstruction can be caused by stones and strictures. The specific cause of obstruction is identified and treated accordingly. Stones are extracted using baskets and balloons, strictures are dilated using catheters and balloons, and drainage across strictures is maintained by the insertion of a plastic or expandable metal stent.

: Biliary stone extraction using a basket.

: Sphincterotomy of the papilla of Vater using a sphincterotome.

: Expandable metal (nitinol) bile duct stent.

: Expandable stent draining the bile duct.

Sphincter of Oddi Manometry

The bile and pancreatic ducts are selectively cannulated with a special manometry catheter to measure the basal pressure and phasic wave contractions of the sphincter of Oddi. A “dysfunctional” sphincter may be the cause of biliary- type pain or recurrent attacks of pancreatitis.

: Manometry catheter inserted into the bile duct to measure sphincter of Oddi pressures.

: Sphincter of Oddi pressure tracing documenting elevated pressures

Ductoscopy

A miniature flexible endoscope is inserted into the bile and pancreatic ducts for endoscopic evaluation. Ductoscopy is performed to clarify indeterminate findings on ERCP and to guide interventional procedures such as tissue sampling and lithotripsy of stones.

: Babyscope inserted into the pancreatic duct.

: Image of a tumor growing within the pancreatic duct (intraductal mucin producing tumor).

Intraductal Shock-Wave Lithotripsy

Ductoscopy is performed to visually guide the fragmentation of impacted stones with electrohydraulic- generated shock waves.

: Babyscope inserted into the bile duct to perform lithotripsy

Drainage of Pancreatic Pseudocysts

Cyst drainage is accomplished through the bowel wall (transmural) or through the pancreatic duct (transpapillary). Endoscopic ultrasonography is used to guide transmural drainage of pseudocysts.

: Puncture of a pseudocyst with placement of a guidewire for pseudocyst drainage.