Atlas of Gastroenterological Endoscopy
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Stenting of biliary and pancreatic duct for recurrent papillary stenosis
Papillary stenosis and purulent cholangitis Congested biliary and biliary duct
Recurrent bouts of cholangitis with a fibrotic papillary stenosis resistent to therapyled to the implantation of a plastic stent. The papillary stenosis also led to chronic pancreatitis with a remarkable dilatation of the pan- creatic duct (x-ray to the right). To the left: The papilla is depicted with a little pus draining from it. Though papillotomized and di- lated several times the stenosis is visible.
Stenting - biductular Stenting of pancreatic and biliary duct
The dilated pancreatic duct corresponding to chronic pancreatic pain was treated by insertion of a prothesis to the pancreatic duct. On the left side the endoscopic picture is shown, the x-ray to the right shows both stents in situ.
Wallstent deployment Wall stent
Stenting of pancreatic and biliary duct Since the biliary stents occluded nearly once in a month, the dicision is made to deploy a wall stent. The upper left picture shows the stent not yet fully ex- panded, on the x-ray above to the right the stent is fully expanded and in the correct position. The left lower endo- scopic picture shows both the pancreatic and the wall stent in the papilla. Since recurrent cholangitis might be induced by biliary metall stents, the indication in this case was an extreme exception. Reasons for metall stenting in this case were the recurrent stent occlusions, the old age of the patient (85) and the comorbidity (maximal surgical risk).