Videos

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 The catheter is then withdrawn over the guidewire (over which a biliary stent may be placed to allow further drainage).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.)