Endoscopy 2005; 37(4): 389-392
DOI: 10.1055/s-2005-861118
Case Report
© Georg Thieme Verlag KG Stuttgart · New York

Therapeutic Endoscopic Retrograde Cholangiopancreatography without Fluoroscopy in Four Critically Ill Patients Using Wire-Guided Intraductal Ultrasound

S.  Stavropoulos1 , A.  Larghi1 , E.  Verna1 , P.  Stevens1
  • 1Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, USA
Further Information

Publication History

Submitted 7 June 2004

Accepted after Revision 3 November 2004

Publication Date:
12 April 2005 (online)

Abstract

Emergent endoscopic retrograde cholangiopancreatography cannot be performed at the bedside in critically ill patients in an intensive care unit because of the requirement for fluoroscopy. Moving such patients to a safe location where fluoroscopy is available can pose practical problems, and can lead to delayed intervention, which may adversely affect the outcome. We report the use of intraductal ultrasound to facilitate therapeutic biliary interventions in four critically ill patients in an intensive care unit. Cannulation was performed endoscopically at the bedside using a sphincterotome and a guide wire. Intraductal ultrasound, rather than fluoroscopy, was then used to confirm the location of the wire within the common bile duct prior to performing endoscopic sphincterotomy or stent placement. This technique was successful in all four patients.

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S. N. Stavropoulos, M. D.

Columbia University Medical Center · Department of Medicine · Division of Digestive and Liver Diseases

630 West 168th Street · P & S 10-508 · New York · NY 10032 · USA

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Email: sns10@columbia.edu