ERCP. El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy

 
Larynx with ictericia (yellowish color). Patient with cholangitis and choledocholithiasis. This 83-year-old male was admitted with abdominal pain and increasing jaundice. Common bile duct stones were diagnosed on abdominal ultrasound.

Video Endoscopy Sequence 1 of 6.

Larynx with ictericia (yellowish color).

Patient with cholangitis and choledocholithiasis.

 This 83-year-old male was admitted with abdominal pain
 and increasing jaundice. Common bile duct stones were
 diagnosed on abdominal ultrasound.

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Hard Palate.

Video Endoscopy Sequence 2 of 6.

Hard Palate.

 
White bilis is emerging from the Vater papila (cholangitis). This picture was taken through a forward-viewing gastroscope.

Video Endoscopy Sequence 3 of 6.

 White bilis is emerging from the Vater papila (cholangitis).

 This picture was taken through a forward-viewing
 gastroscope.
Vaterīs papilla is observed protrued

Video Endoscopy Sequence 4 of 6.

Vaterīs papilla is observed protrued

 
The principal indications for sphincterotomy include removal of common bile duct stones, treatment of papillary stenosis, and facilitation of endotherapy (ie, stent placement, tissue sampling, and stricture dilation).

Video Endoscopy Sequence 5 of 6.

 The principal indications for sphincterotomy include
 removal of common bile duct stones, treatment of papillary
 stenosis, and facilitation of endotherapy (ie, stent
 placement, tissue sampling, and stricture dilation).
ERCP. Endoscopic Sphincterotomy and Stone Extraction. Although most stones <1cm in diameter will pass spontaneously in days or weeks following an adequate sphinterectomy, most experts prefer to extract them directly. This immediately clarifies the situation and reduces the risk of impactiona nd cholangitis.

Video Endoscopy Sequence 6 of 6.

ERCP.

Endoscopic Sphincterotomy and Stone Extraction.

 Although most stones <1cm in diameter will pass
 spontaneously in days or weeks following an adequate
 sphinterectomy, most experts prefer to extract them
 directly. This immediately clarifies the situation and
 reduces the risk of impaction and cholangitis.
Adenocarcinoma of the head of the Pancreas that infiltrates the wall of duodenum. A 58 year-old male with heavy drinking habits, presented with jaudince and weigh loss of 30 pounds, the ultrasound examinations reveled dilatation of the biliary tree and a mass of the pancreatic head.

Video Endoscopy Sequence 1 of 10.

 Adenocarcinoma of the head of the Pancreas that infiltrates
 the wall of duodenum.

 A 58 year-old male with heavy drinking habits, presented
 with jaudince and weigh loss of 30 pounds, the ultrasound
 examinations reveled dilatation of the biliary tree and
 a mass of the pancreatic head.
The image and the video clip display an irregular and nodular patterns of the periampullary region.

Video Endoscopy Sequence 2 of 10.

 The image and the video clip display an irregular and
 nodular patterns of the periampullary region.
A biopsy was taken with an Endoscopic snare excision.

Video Endoscopy Sequence 3 of 10.

 A biopsy was taken with an endoscopic snare excision.

 
The Vater papilla is observed.

Video Endoscopy Sequence 4 of 10.

 The Vater papilla is observed.
An endoscopic sphincterotomy was attempted at standard common bile duct cannulation and sphincterotomy were unsuccessful, then precut sphincterotomy needle-nife sphincterotomy was performed.

Video Endoscopy Sequence 5 of 10.

 An endoscopic sphincterotomy was attempted at standard
 common bile duct cannulation and sphincterotomy were
 unsuccessful, then precut sphincterotomy needle-nife
 sphincterotomy was performed.

 
Precut sphincterotomy needle-nife sphincterotomy.

Video Endoscopy Sequence 6 of 10.

 Precut sphincterotomy needle-nife sphincterotomy.
 

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Video Endoscopy Sequence 7 of 10.

 
A guide-wire placement to deploy a self-expanding stent used for drainage of malignant biliary stenosis. Sphincterotomy is a technically complex procedure that is performed under visual and fluoroscopic guidance. Deep cannulation of the bile duct is followed by electrocautery to incise the sphincter of Oddi.

Video Endoscopy Sequence 8 of 10.

 A guide-wire placement to deploy a self-expanding stent
 used for drainage of malignant biliary stenosis.

 Sphincterotomy is a technically complex procedure that is
 performed under visual and fluoroscopic guidance. Deep
 cannulation of the bile duct is followed by electrocautery to
 incise the sphincter of Oddi.

 
A dilated biliar tree is observed with this ERCP image.

Video Endoscopy Sequence 9 of 10.

 A dilated biliar tree is observed with this ERCP image.
A dilated biliar tree is observed

Video Endoscopy Sequence 10 of 10.

A dilated biliar tree is observed.

 
Adenocarcinoma of the Vater Papilla and stent migration. A 62 year-old male with adenocarcinoma of Papilla of Vater, a biliar stent was placed in another clinic, the stent migrated one month after, patient present anorexia, nauseas and vomiting. Endoprostheses are commonly used in the treatment of biliary and pancreatic disorders incidence rates of 4.% for proximal biliary stent migration.

Video Endoscopy Sequence 1 of 7.

Adenocarcinoma of the Vater Papilla and stent migration.

 A 62 year-old male with adenocarcinoma of Papilla of
 Vater, a biliar stent was placed in another clinic, the stent
 migrated one month after, patient presented anorexia,
 nauseas and vomiting. The stent caused contralateral wall
 ulceration with the danger of causing duodenal perforation.

 Endoprostheses are commonly used in the treatment of
 biliary and pancreatic disorders incidence rates of 4.% for
 proximal biliary stent migration.

 

 
This image displays the adenocarcinoma of papilla of Vater. Because of its location with respect to the biliary system, carcinoma of the ampulla of Vater is considered to manifest earlier in its course of development than carcinoma of the pancreas. The most common physical finding is jaundice, which occurs in 93-100% of cases.Endoprosthesis which was then inserted into malignant strictures of the ampulla .

Video Endoscopy Sequence 2 of 7.

This image displays the adenocarcinoma of papilla of Vater.

 Endoprosthesis which was inserted into malignant strictures
 of the ampulla.

 Because of its location with respect to the biliary system,
 carcinoma of the ampulla of Vater is considered to manifest
 earlier in its course of development than carcinoma of the
 pancreas. The most common physical finding is jaundice,
 which occurs in 93-100% of cases.
Carcinoma of the ampulla of Vater is a malignant tumor arising within 2 cm of the distal end of the common bile duct, where it passes through the wall of the duodenum and ampullary papilla. The common bile duct merges with the pancreatic duct of Wirsung at this point and exits through the ampulla into the duodenum. The most distal portion of the common bile duct is dilated.

Video Endoscopy Sequence 3 of 7.

 Periampullary Carcinoma.

 Carcinoma of the ampulla of Vater is a malignant tumor
 arising within 2 cm of the distal end of the common bile
 duct, where it passes through the wall of the duodenum and
 ampullary papilla. The common bile duct merges with the
 pancreatic duct of Wirsung at this point and exits through
 the ampulla into the duodenum. The most distal portion of
 the common bile duct is dilated.

 
Ampullary cancer accounts for approximately 0.2% of all gastrointestinal tract malignancies. The Courvoisier sign, painless jaundice associated with a palpable gallbladder, may be present. Unlike that due to a neoplasm, obstructive jaundice due to a stone causes scarring of the gallbladder, precluding its distension.

Video Endoscopy Sequence 4 of 7.

 Ampullary cancer accounts for approximately 0.2% of all
 gastrointestinal tract malignancies.

 The Courvoisier sign, painless jaundice associated with a
 palpable gallbladder, may be present. Unlike that due to a
 neoplasm, obstructive jaundice due to a stone causes
 scarring of the gallbladder, precluding its distension.

 Although biopsy is not 100% accurate.
This image as well as the video clip display the tip of the stent that ulcerated the contralateral wall of the duodenum.

Video Endoscopy Sequence 5 of 7.

 This image as well as the video clip display the tip of the
 stent that ulcerated the contralateral wall of the duodenum.

This image Shows the tip of the stent causing a duodenal wall ulceration with the danger of perforation.

Video Endoscopy Sequence 6 of 7.

 This image Shows the tip of the stent causing a duodenal
 wall ulceration with the danger of perforation.

 
More images and video clip of this case.

Video Endoscopy Sequence 7 of 7.

More images and video clip of this case.

 
LARGE BULGING PAPILLA OF VATER. A 87 year-old male, with 10 months after cholecystectomy due to gallstones, presented 20 days of fever, diarrhea, jaundice and upper right quadrant pain. Abdominal sonography demonstrated the intrahepatic ducts, comom hepatic duct, and choledocho were dilated. Total Bilirrubine was of 3.0 mg/dl with a direct bilirrubine of 2.6 mg/dl and Alkaline Fosfatase of 812. Duodenoscopic sphincterotomy of the papilla of Vater as performed using a standard side-viewing duodenoscope.

Video Endoscopic Sequence 1 of 2.

LARGE BULGING PAPILLA OF VATER.

 An 87 year-old male, with 10 months after cholecystectomy
 due to gallstones, presented 20 days of fever, diarrhea,
 jaundice and upper right quadrant pain. Abdominal
 sonography demonstrated the intrahepatic ducts, comom
 hepatic duct, and choledocho were dilated. Total Bilirrubine
 was of 3.0 mg/dl with a direct bilirrubine of 2.6 mg/dl and
 Alkaline Fosfatase of 812. Duodenoscopic sphincterotomy
 of the papilla of Vater was performed using a standard
 side-viewing duodenoscope.
 
 
A point diathermy incision was made with a precut papillotome (needle-knife). When the papillotome advanced sufficiently, gush of bile and small gallstone were observed. Slight bleeding was observed. 3 days later, the patient reduced total bilirrubine to 1mg/dl, abdominal sonography was normal.

Video Endoscopic Sequence 2 of 2.

 A point diathermy incision was made with a precut
 papillotome (needle-knife). When the papillotome
 advanced sufficiently, gush of bile and small gallstone were
 observed. Slight bleeding was observed. 3 days later, the
 patient reduced total bilirrubine to 1 mg/dl, abdominal
 sonography was normal.
Stent Migration. This 73 year-old male underwent placement of a biliary stent due to Klatskin?s tumors in another clinic. Endoscopic plastic biliary stenting is a common procedure in the management of benign biliary pathology. Complications from biliary stenting are rare, with stent occlusion being the most common. Another late complication of long-term biliary stenting is stent migration, which occasionally can result in bowel perforation and obstruction.

Stent Migration.

 This 73 year-old male underwent placement of a biliary
 stent due to Klatskin’s tumors in another clinic.

 Endoscopic plastic biliary stenting is a common procedure
 in the management of benign biliary pathology.
 Complications from biliary stenting are rare, with stent
 occlusion being the most common. Another late
 complication of long-term biliary stenting is stent migration,
 which occasionally can result in bowel perforation and
 obstruction.
Magnetic Cholangio Resonance. This 31 year-old lady, 8 years previously had an open cholecystectomy due to acute calculous cholecystitis and a biliodigestive surgery; Roux-en-Y, after that, has been suffering of repeated episodes of cholangitis, the magnetic cholangio resonance shows recurrent stones in the the biliar tree with stenosis of the anastomosis of the asa with the biliar tree, the patient underwent a new surgery.

Magnetic Cholangio Resonance

 This 31 year-old lady, 8 years previously had an open
 cholecystectomy due to acute calculous cholecystitis and
 a biliodigestive surgery; Roux-en-Y, after that, has been
 suffering of repeated episodes of cholangitis, the magnetic
 cholangio resonance shows recurrent stones in the the
 biliar tree with stenosis of the anastomosis of the asa with
 the biliar tree, the patient underwent a new surgery.

 
 Magnetic resonance Cholangiopancreatography (MRCP) is a
 non-invasive imaging technique able to provide projectional
 images of the bile ducts without any contrast.

 Different sequences , using both breath-hold and
 non-breath-hold acquisition techniques, have been employed in
 order to obtain MRCP images.

 The main indication for MRCP study is represented by the
 evaluation of common bile duct obstruction, with the aim of
 assessing the presence of the obstruction (accuracy 85-100%)
 and, subsequently, its level (accuracy 91-100%) and its cause.
 The utility of associating conventional MR images to MRCP in
 malignant strictures, in order to characterize and stage the
 malignant lesion, is also discussed. Finally, data are presented
 regarding the indications and the utility of MR-pancreatography
 in the evaluation of patients with pancreatic duct anomalies and
 chronic pancreatitis.