Laparoscopic cholecystectomy has been performed on a large scale since the early nineties. 

Understanding bilio-pancreatic anatomy is fundamental in ERCP. ERCP is the most difficult procedure in gastrointestinal endoscopy, and most of it is related to anatomy. Anatomy in ERCP is expressed on X-rays on cholangiopancreatography. 

Lecture during Nov 19 session.

Successful endoscopic therapy in the bilio-pancreatic region is dependent on a correct understanding of the indications and possibilities of endoscopic therapy.

ERCP is an endoscopic procedure that requires a good understanding of the anatomy of the bilio-pancreatic region and the use of dedicated accessories and instruments.

Placement of plastic and metal stents in the bile duct and the pancreatic duct is one of the most common therapeutical maneuvers during ERCP. According to the indication of the procedure and the etiology of the disease (bening vs. malignant), stenting can be temporary or definitive.

Lecture during Nov 19 session.

Iatrogenic bile duct injuries after surgery remain a substantial problem in gastrointestinal surgery. A variety of injuries can occur.

Obstructive jaundice and bile leaks are indications for percutaneous biliary interventions. Uncomplicated obstructive jaundice is not an emergency, while septic cholangitis needs urgent intervention.

Since the first report of the opacification of the biliary system by percutaneous direct puncture of the gallbladder in 1921, biliary interventions have evolved a great deal becoming readily available in most hospital settings.

Multiple classification schemes exist for bile duct injuries (BDI). While the classification by Bismuth and Lazorthes is customary for open surgery, it has been extended by various authors for laparoscopic surgery (such as the Strasberg and Stewart-Way classifications).

Management of bile duct injuries requires hepatobiliary expertise and transdisciplinary collaboration. Minimally invasive approaches such as endoscopic and percutaneous treatment options have traditionally served as a bridge to surgical repair.

There is an increasing number of percutaneous cholecystostomies carried out in the last years in patients unfit for surgery. The access can be subcostal or intercostal, transhepatic or transperitoneal. Generally, a direct approach using ultrasound is preferred to CT- or fluoroscopy guidance.

The incidence of open and laparoscopic common bile duct exploration for choledocholithiasis has remarkably declined during the last 2 decades. Endoscopic and percutaneous treatment options provide a minimally invasive solution to even complex biliary lithiasis cases.

Biliary leaks and strictures are the most frequent complications after HPB surgery. When suspecting a bile leak after liver resection ERCP allows to both confirm and localize the leak and to treat it by sphincterotomy and stent placement.

Although nonsurgical methods produce high clinical success rates in the treatment of benign biliary stricture, conventional methods are not always successful in cases of severe biliary stricture or complete obstruction. 

Malignant biliary obstruction most commonly arises from cholangiocarcinoma and pancreatic cancer or as a metastasis from other cancer types. Most of the patients, at the time of diagnosis, are at an advanced stage of the disease that precludes surgical resection.

 This lesson has no pdf & no quiz

 This lesson has no pdf & no quiz

 This lesson has no pdf & no quiz

 This lesson has no pdf & no quiz

 This lesson has no pdf & no quiz

 This lesson has no pdf & no quiz

Replay of webinar held on March 8, 2022

ERCP relevant anatomy Ivo Boškoski

Evaluation of the papilla and positioning; Scope maneuvering and use of the elevator; Cannulation; Difficult anatomy Theodor Voiosu