Practical Gastroenterology and Hepatology Board Review Toolkit

Nicholas J. Talley , Kenneth R. Devault, Michael B. Wallace, Bashar A. Aqel, Keith D. Lindor


74.6 Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography. The video begins with the view of the ampulla of Vater (upper right-hand corner), and a catheter tip (right-hand lower corner) extending from the side-viewing endoscope. Note the yellowish bulge at the opening of the ampulla, which indicates the build-up of purulent material within the common bile duct (CBD), which is characteristic of suppurative cholangitis. The ampulla is then cannulated and a papillotomy wire used to perform a sphincterotomy, leading to decompression of the CBD. Along with copious purulent material, multiple gallstones flow through the ampulla. The catheter is then withdrawn over the guidewire (over which a biliary stent may be placed to allow further drainage). (Courtesy of M. Edwyn Harrison, MD.)