I think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.
I think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.
I think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.
I think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.
This patient, currently undergoing treatment for acute lymphoblastic leukemia, or ALL, presents with right upper quadrant pain. He's neutropenic, has markedly elevated liver function tests, and ultrasound findings are consistent with acute cholecystitis and cholecystitis.
This patient, currently undergoing treatment for acute lymphoblastic leukemia, or ALL, presents with right upper quadrant pain. He's neutropenic, has markedly elevated liver function tests, and ultrasound findings are consistent with acute cholecystitis and cholecystitis.
clinicalStudies show that if you wait one day when a patient comes in with acute biliary pancreatitis and the amylase/lipase go up, then you do ERCP because the stone is impacted; but most of the time the levels will go right down as the stone passes spontaneously, and you can proceed to cholecystectomy.↗
quoteThis patient, currently undergoing treatment for acute lymphoblastic leukemia, or ALL, presents with right upper quadrant pain. He's neutropenic, has markedly elevated liver function tests, and ultrasound findings are consistent with acute cholecystitis and cholecystitis.↗
▶Ep 3 · 0:53
clinicalA 16-year-old male with acute lymphoblastic leukemia (ALL), neutropenic and thrombocytopenic, presented with right upper quadrant pain, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis.↗
▶Ep 3 · 1:18
opinionOver 50% of the live and virtual audience poll opted to start antibiotics and address the elevated liver function tests in the neutropenic thrombocytopenic patient.↗
▶Ep 3 · 1:27
clinicalDr. Neff's patient spontaneously passed the stone, LFTs came back down, counts recovered, and the patient proceeded to elective cholecystectomy.↗
▶Ep 3 · 2:24
quoteWhen things are improving, we don't need to see biochemical normalization. But when the symptoms are improving, we go right to cholecystectomy with intraoperative cholangiogram and coordinate with you just in case there might be a need for an ERCP.↗
▶Ep 3 · 2:24
clinicalWhen symptoms are improving in gallstone pancreatitis, cholecystectomy with intraoperative cholangiogram can proceed without waiting for biochemical normalization, coordinating with ERCP availability if needed.↗
▶Ep 3 · 2:59
clinicalMost biliary stones can be cleared, and some stones pass spontaneously, requiring good clinical judgment.↗
▶Ep 3 · 3:07
opinionLocal resources and what is available must be factored into management decisions for biliary stones.↗
Choledocholithiasis with Drs. David Vitale & Lucas Neff
▶Ep 2 · 0:55
quoteWe know that there are metabolic risk factors, uh, hemolysis such as sickle cell, congenital and biliary anomalies like colloidal cysts.↗
▶Ep 2 · 0:55
clinicalRisk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts.↗
▶Ep 2 · 1:03
epidemiologicalCholedocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity.↗
▶Ep 2 · 1:52
quoteThis slide is actually taken from ASGE, uh, which is the Adult Endoscopy Society for GI.↗
▶Ep 2 · 1:52
host_summaryAccording to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP.↗
▶Ep 2 · 2:40
host_summaryIn pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones.↗
▶Ep 2 · 3:03
host_summaryThe pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL.↗
▶Ep 2 · 3:41
host_summaryPediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay.↗
▶Ep 2 · 4:03
opinionRetrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise.↗
▶Ep 2 · 4:09
quoteI really think again it gets back to institution dependent expertise and it's probably provider dependent and the institution's experience with this.↗
▶Ep 2 · 4:39
clinicalStones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult.↗
▶Ep 2 · 5:00
opinionLocal expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration.↗
▶Ep 2 · 5:00
quoteI think, uh, local expertise and availability is probably the most important thing in this decision tree.↗
▶Ep 2 · 11:23
clinicalNever use a balloon larger than the dilated common bile duct, as adult literature shows higher rates of pancreatitis with ampullary dilation without sphincterotomy.↗
▶Ep 2 · 11:23
quoteI think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.↗
Choledocholithiasis with Drs. David Vitale & Lucas Neff
▶Ep 3 · 0:55
quoteWe know that there are metabolic risk factors, uh, hemolysis such as sickle cell, congenital and biliary anomalies like colloidal cysts.↗
▶Ep 3 · 0:55
clinicalRisk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts.↗
▶Ep 3 · 1:03
epidemiologicalCholedocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity.↗
▶Ep 3 · 1:52
guidelineAccording to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP.↗
▶Ep 3 · 1:52
quoteThis slide is actually taken from ASGE, uh, which is the Adult Endoscopy Society for GI.↗
▶Ep 3 · 2:40
clinicalIn pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones.↗
▶Ep 3 · 3:03
clinicalThe pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL.↗
▶Ep 3 · 3:41
clinicalPediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay.↗
▶Ep 3 · 4:03
opinionRetrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise.↗
▶Ep 3 · 4:09
quoteI really think again it gets back to institution dependent expertise and it's probably provider dependent and the institution's experience with this.↗
▶Ep 3 · 4:39
clinicalStones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult.↗
▶Ep 3 · 5:00
opinionLocal expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration.↗
▶Ep 3 · 5:00
quoteI think, uh, local expertise and availability is probably the most important thing in this decision tree.↗
▶Ep 3 · 11:23
quoteI think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.↗
▶Ep 3 · 11:23
clinicalNever use a balloon larger than the dilated common bile duct, as adult literature shows higher rates of pancreatitis with ampullary dilation without sphincterotomy.↗
clinicalStudies show that if you wait one day when a patient comes in with acute biliary pancreatitis and the amylase/lipase go up, then you do ERCP because the stone is impacted; but most of the time the levels will go right down as the stone passes spontaneously, and you can proceed to cholecystectomy.↗
▶Ep 24 · 2:38
clinicalStudies show that if you wait one day when a patient comes in with acute biliary pancreatitis and the amylase/lipase go up, then you do ERCP because the stone is impacted; but most of the time the levels will go right down as the stone passes spontaneously, and you can proceed to cholecystectomy.↗
clinicalA 16-year-old male with acute lymphoblastic leukemia (ALL), neutropenic and thrombocytopenic, presented with right upper quadrant pain, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis.↗
▶Ep 27 · 0:53
quoteThis patient, currently undergoing treatment for acute lymphoblastic leukemia, or ALL, presents with right upper quadrant pain. He's neutropenic, has markedly elevated liver function tests, and ultrasound findings are consistent with acute cholecystitis and cholecystitis.↗
▶Ep 27 · 0:53
clinicalA 16-year-old male with acute lymphoblastic leukemia (ALL), neutropenic and thrombocytopenic, presented with right upper quadrant pain, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis.↗
▶Ep 27 · 0:53
quoteThis patient, currently undergoing treatment for acute lymphoblastic leukemia, or ALL, presents with right upper quadrant pain. He's neutropenic, has markedly elevated liver function tests, and ultrasound findings are consistent with acute cholecystitis and cholecystitis.↗
▶Ep 27 · 1:18
opinionOver 50% of the live and virtual audience poll opted to start antibiotics and address the elevated liver function tests in the neutropenic thrombocytopenic patient.↗
▶Ep 27 · 1:18
opinionOver 50% of the live and virtual audience poll opted to start antibiotics and address the elevated liver function tests in the neutropenic thrombocytopenic patient.↗
▶Ep 27 · 1:27
clinicalDr. Neff's patient spontaneously passed the stone, LFTs came back down, counts recovered, and the patient proceeded to elective cholecystectomy.↗
▶Ep 27 · 1:27
clinicalDr. Neff's patient spontaneously passed the stone, LFTs came back down, counts recovered, and the patient proceeded to elective cholecystectomy.↗
▶Ep 27 · 2:24
quoteWhen things are improving, we don't need to see biochemical normalization. But when the symptoms are improving, we go right to cholecystectomy with intraoperative cholangiogram and coordinate with you just in case there might be a need for an ERCP.↗
▶Ep 27 · 2:24
clinicalWhen symptoms are improving in gallstone pancreatitis, cholecystectomy with intraoperative cholangiogram can proceed without waiting for biochemical normalization, coordinating with ERCP availability if needed.↗
▶Ep 27 · 2:24
quoteWhen things are improving, we don't need to see biochemical normalization. But when the symptoms are improving, we go right to cholecystectomy with intraoperative cholangiogram and coordinate with you just in case there might be a need for an ERCP.↗
▶Ep 27 · 2:24
clinicalWhen symptoms are improving in gallstone pancreatitis, cholecystectomy with intraoperative cholangiogram can proceed without waiting for biochemical normalization, coordinating with ERCP availability if needed.↗
▶Ep 27 · 2:59
clinicalMost biliary stones can be cleared, and some stones pass spontaneously, requiring good clinical judgment.↗
▶Ep 27 · 2:59
clinicalMost biliary stones can be cleared, and some stones pass spontaneously, requiring good clinical judgment.↗
▶Ep 27 · 3:07
opinionLocal resources and what is available must be factored into management decisions for biliary stones.↗
▶Ep 27 · 3:07
opinionLocal resources and what is available must be factored into management decisions for biliary stones.↗
Choledocholithiasis with Drs. David Vitale & Lucas Neff
▶Ep 26 · 0:55
clinicalRisk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts.↗
▶Ep 26 · 0:55
quoteWe know that there are metabolic risk factors, uh, hemolysis such as sickle cell, congenital and biliary anomalies like colloidal cysts.↗
▶Ep 26 · 0:55
clinicalRisk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts.↗
▶Ep 26 · 0:55
quoteWe know that there are metabolic risk factors, uh, hemolysis such as sickle cell, congenital and biliary anomalies like colloidal cysts.↗
▶Ep 26 · 1:03
epidemiologicalCholedocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity.↗
▶Ep 26 · 1:03
epidemiologicalCholedocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity.↗
▶Ep 26 · 1:52
host_summaryAccording to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP.↗
▶Ep 26 · 1:52
quoteThis slide is actually taken from ASGE, uh, which is the Adult Endoscopy Society for GI.↗
▶Ep 26 · 1:52
quoteThis slide is actually taken from ASGE, uh, which is the Adult Endoscopy Society for GI.↗
▶Ep 26 · 1:52
guidelineAccording to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP.↗
▶Ep 26 · 2:40
clinicalIn pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones.↗
▶Ep 26 · 2:40
host_summaryIn pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones.↗
▶Ep 26 · 3:03
host_summaryThe pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL.↗
▶Ep 26 · 3:03
clinicalThe pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL.↗
▶Ep 26 · 3:41
clinicalPediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay.↗
▶Ep 26 · 3:41
host_summaryPediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay.↗
▶Ep 26 · 4:03
opinionRetrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise.↗
▶Ep 26 · 4:03
opinionRetrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise.↗
▶Ep 26 · 4:09
quoteI really think again it gets back to institution dependent expertise and it's probably provider dependent and the institution's experience with this.↗
▶Ep 26 · 4:09
quoteI really think again it gets back to institution dependent expertise and it's probably provider dependent and the institution's experience with this.↗
▶Ep 26 · 4:39
clinicalStones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult.↗
▶Ep 26 · 4:39
clinicalStones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult.↗
▶Ep 26 · 5:00
opinionLocal expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration.↗
▶Ep 26 · 5:00
opinionLocal expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration.↗
▶Ep 26 · 5:00
quoteI think, uh, local expertise and availability is probably the most important thing in this decision tree.↗
▶Ep 26 · 5:00
quoteI think, uh, local expertise and availability is probably the most important thing in this decision tree.↗
▶Ep 26 · 11:23
clinicalNever use a balloon larger than the dilated common bile duct, as adult literature shows higher rates of pancreatitis with ampullary dilation without sphincterotomy.↗
▶Ep 26 · 11:23
quoteI think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.↗
▶Ep 26 · 11:23
quoteI think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.↗
▶Ep 26 · 11:23
clinicalNever use a balloon larger than the dilated common bile duct, as adult literature shows higher rates of pancreatitis with ampullary dilation without sphincterotomy.↗
