How do I get into the bile duct?

ERCP remains among the big challenges of GI endoscopy, because of the complexity of the procedure, as well as the inherent risks. Both relate to a great extent to ability to cannulate the papilla safely and consistently. While this is oftentimes easy, it is important to develop a lineup of alternative strategies when things are difficult. This can be due to problems with duodenal access, peripapillary positioning, ampullary anatomy or just plain “difficult papillas”. This webinar addresses some of these issues and suggestions on how to address them.
Moderator: Professor Konstantinos Triantafyllou,
Presenter: Professor Lars Aabakken

[@lisaeischens2352]

I’m a 50 year old woman who had a lap chole 1 year ago with no improvement of symptoms to the contrary, I’m doing much worse and I don’t feel like any of my doctors seem to care. I’m a Registered Nurse who is disabled so I have some ability to research and I believe that my problem is within the CBD and maybe specifically a Sphincter of Oddi stenosis. This I’m coming to the conclusion of over 6 years of CT’s and the gallbladder surgery a year ago which I had as an outpatient but short after I got up to sit in the chair, I started to black out. I kept telling them that I couldn’t sit up without fainting so after 2 liters of wide open fluids, they had to keep me overnight. I had a night from hell with no pain meds other than what I already take for my numerous musculoskeletal issues. My stomach and pelvis was huge which I told the nurses. I only voided 1 time after my surgery. I was in so much pain all night with my stomach muscles having spasms and rigidity. I couldn’t breathe properly because of the pain and the pressure. Surgeon came in at 7 am and said my Hemoglobin was 7 so after 2 units RBC’s I would get another CT which showed 2 large areas of bleeding, one large pool that went down in to my groin and a large hematoma in the surgical area. The surgeon told me right after my surgery that I had a lot of inflammation of the gallbladder and gave me a picture that looked like they must of cauterized the entire surface of the area near the liver. I went back to the OR and they couldn’t find where the site of bleeding was from and luckily it had stopped on it’s own or I probably wouldn’t be here right now, they put in a JP drain that I had for 2 weeks. I also had bilateral atelectasis and a pleural effusion of my right lung which is why I couldn’t breathe as I wasn’t able to expand my lungs no matter how I tried. Over the years my CBD went from 7 and now it is 14mm. I noticed on one of my CT’s that the terminology noted a tapering near the ampulla vater. I have terrible and near constant GERD, bloating of my upper abdomen, and epigastric pain that is sometimes barely noticeable to very painful with a percolating feeling to the left of my right umbilical area of about 2 inches. It almost feels like when a baby moves around when you’re heavily pregnant, a strange pulling. I went to my primary and had labs that showed elevated liver enzymes that were 3 times higher than they should be. Lipase normal. Another CT showed hepatic dilation and an enlarged pancreatic head. I had upper and lower endoscopy which only revealed a mildly reactive fungal infection likely Candida which I was prescribed Nystatin for after waiting over 2 weeks to hear from anyone so I had to call in to get this and I’m having a hard time taking it because I’m not eating well and made the mistake of taking it at night on an empty stomach and it immediately caused pain and burning in my stomach. The only thing that has helped me stop that pain was the Kombucha my daughter had me try. I was doing some research and read that with gallbladder and bile duct problems that a person can have an elevated PT/INR I’m assuming is because the bile isn’t able to break down my vitamin K and maybe this is why I had the postoperative bleeding? I also have sudden nausea that will strike especially if I’ve drank a lot of water for some weird reason and I have large amounts of green bile that comes up. This has been a new symptom the last couple of months. I’m pretty damn sure this is something that can’t be left to get much worse or I will likely get liver and pancreatic damage. I’m getting so depressed with having to be my own doctor as it seems like no one I have seen is helping me or even gets back to me. All the CT report concluded was Biliary Dilation. There was also something noted in the upper GI about a Z Line in my stomach but the report was messed up with one line of writing on top of the one above something about slight Z Line. It could be nothing or it sounds like it could be related to a Barrett’s Esophagus but I guess I’m more concerned about my biliary problems that are ruining my life when I already have chronic pain. I’m aware that pain meds can cause problems with this area but don’t know how I’m supposed to go on like this. Between all this and the onset of Menopause, I’m about ready to say fuck it all and would jump of the ride already if it wasn’t for my kids and grandkids. My husband is probably sick of me because I never feel good and then when the doctors are so wishy washy with not telling me anything, he probably thinks I’m just exaggerating or depressed which no shit I am and have been for years but I’m reaching my limits. I’m probably typing this to no one and I’m tempted to delete it like I usually do but this time I’m going to send it through. An additional note, all last summer I kept looking in the mirror and was seeing that my skin looked yellowish and I would ask my husband and he said he didn’t see it but I definitely did and would’ve been more worried if I could see it in my eyes but it was mainly the color of my skin that was also tan so it wasn’t obvious but in light of everything with my liver enzymes, I probably wasn’t just seeing things.

[@Jean-nf8mj]

Same here!

[@corneliadnl1070]

thank you for sharing these very helpful tricks :)