• A 78 yrs female patient came to us for the favor of endotherapy for a single angiomatous lesion seen on previous capsule endoscopy performed elsewhere. Patient has h/o occult G.I. blood loss that required blood transfusions and iron preparation repeatedly for the last 2 years.
  • Antegrade Single Balloon Enteroscopy was performed under general anaesthesia.
  • Scope was passed almost upto 90 cms beyond the DJ flexure and multiple (in total 7) angiodysplastic lesions were seen. No other lesions were seen distal to the last lesion.
  • All the lesions were fulgurated with bipolar heater probe coagulation and Coag grasper forceps to achieve complete haemostasis.

SBE showed angioplastic lesion seen in the Jejunum

Narrow band imaging showed classical spider like appearance of the angiodysplastic lesion

 

 

 

 

 

 

 

 

SBE showed multiple angioplastic lesion seen in the Jejunum

Bipolar heater probe coagulation was then performed on the lesion

 

 

 

 

 

 

 

 

Coag grasper forceps to achieve complete haemostasis

Post fulguration appearance of the treated lesion

A 4 yrs old female child was referred to us for the favour of EUS to evaluate a suspicious filling defect in the lower CBD seen on USG abdomen with essentially normal LFT. However, patient has pain in the right hypo quandrium and gall bladder also appeared distended with ? stone on other imaging. In view of these findings EUS and ERC was considered as LFT was essentially normal.

EUS revealed slightly dilated CBD 7 mm with a 5 mm stone badly impacted just above the ampulla of vater in the lower CBD.

  • Gall bladder appeared distended with sludge and imaging microliths with changes of cholecystitis and cholesterol polyp. Pancreas and MPD appeared normal
  • Selective cannulation of bile duct was achieved only after a precut sphincterotomy.
  • Cholangiogram confirmed the EUS findings.
  • Stone extraction was carried out with balloon catheter and dormia basket.
  • A 5 fr single pigtail stent was placed in the CBD to ensure free flow of bile and a 3 fr stent in the MPD to minimize the risk of pancreatitis

EUS revealed slightly dilated CBD 7 mm

5 mm stone badly impacted just above the ampulla of vater in the lower CBD

 

 

 

 

 

 

 

 

A precut sphincterotomy performed

Selective cannulation of CBD

 

 

 

 

 

 

 

Cholangiogram confirmed the EUS findings

Stone extraction was carried out with balloon catheter and dormia basket.

 

 

 

 

 

 

 

 

A 5 fr single pigtail stent was placed to ensure free flow of bile and a 3 fr stent
in the MPD

Stent was placed in the both duct on fluoroscopy