There's been some studies done to show if you wait one day when the patient comes in with acute biliary pancreatitis, if the amylase lipase go up, then you do the ERCP because you have it impacted. But most of the time, it will go right down. And if it starts going down, they pass the stone and you can go to cholecystectomy.
There's been some studies done to show if you wait one day when the patient comes in with acute biliary pancreatitis, if the amylase lipase go up, then you do the ERCP because you have it impacted. But most of the time, it will go right down. And if it starts going down, they pass the stone and you can go to cholecystectomy.
There's been some studies done to show if you wait one day when the patient comes in with acute biliary pancreatitis, if the amylase lipase go up, then you do the ERCP because you have it impacted. But most of the time, it will go right down. And if it starts going down, they pass the stone and you can go to cholecystectomy.
Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage. This blockage prevents pancreatic enzymes from reaching the small intestine, leading them to accumulate and damage the pancreas.
We know the dominant paradigm across the country is an MRCP very often followed by an ERCP, but surgeons should be comfortable dealing with issues in the common bile duct, and resource utilization is a real thing.
We know the dominant paradigm across the country is an MRCP very often followed by an ERCP, but surgeons should be comfortable dealing with issues in the common bile duct, and resource utilization is a real thing.
quoteThis is a 16 year old. This is actually a patient of mine from about 4 months ago.↗
▶Ep 2 · 1:13
quoteSo now we have a little bit more of a different situation with the neutropenia. Thrombocytopenic patient, what are we going to do?↗
▶Ep 2 · 1:31
quoteAnd he spontaneously passed the stone, LFTs came back down. We were able to get him, his counts recovered and get him to elective cholecystectomy.↗
▶Ep 2 · 1:31
clinicalThe patient spontaneously passed the stone, LFTs came back down, counts recovered, and he proceeded to elective cholecystectomy.↗
▶Ep 2 · 2:59
opinionMost stones can be cleared, some stones pass spontaneously, and good clinical judgment with local resources must be factored into management decisions.↗
▶Ep 2 · 3:01
quoteMost stones can be cleared. Some stones pass spontaneously, right? We have to use good judgment with that and local resource. You have to factor in what you have available to you.↗
quoteGallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage. This blockage prevents pancreatic enzymes from reaching the small intestine, leading them to accumulate and damage the pancreas.↗
▶Ep 3 · 1:39
clinicalGallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas.↗
▶Ep 3 · 2:07
opinionSome surgeons will do cholecystectomy within a few days for gallstone pancreatitis, while others will wait for a week.↗
▶Ep 3 · 2:15
quoteFrom an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, we're not jumping in to go do this case right away.↗
▶Ep 3 · 2:15
clinicalFrom an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away for gallstone pancreatitis.↗
▶Ep 3 · 2:38
clinicalIf amylase and lipase continue to rise one day after presentation with acute biliary pancreatitis, ERCP should be performed because the stone is likely impacted.↗
▶Ep 3 · 2:38
clinicalStudies have shown that if amylase and lipase levels go up when a patient comes in with acute biliary pancreatitis and then start going down, the stone has likely passed and the patient can proceed to cholecystectomy.↗
▶Ep 3 · 2:38
quoteThere's been some studies done to show if you wait one day when the patient comes in with acute biliary pancreatitis, if the amylase lipase go up, then you do the ERCP because you have it impacted. But most of the time, it will go right down. And if it starts going down, they pass the stone and you can go to cholecystectomy.↗
Choledocholithiasis with Drs. David Vitale & Lucas Neff
▶Ep 2 · 5:17
quoteWe know the dominant paradigm across the country is an MRCP very often followed by an ERCP, but surgeons should be comfortable dealing with issues in the common bile duct, and resource utilization is a real thing.↗
▶Ep 2 · 6:42
quoteUm, so we, our mantra is all stones go forward.↗
▶Ep 2 · 7:30
quoteIf you're having to open up the common bile duct to extract the stone and you had ERCP capability, I think that that's probably in most cases, not the right thing to do.↗
▶Ep 2 · 7:45
quoteWe've created a card and actually, we want to keep this as cheap as possible, 5 or 6 French urethral stent, $7.↗
▶Ep 2 · 8:24
quoteAnd everything we do is over a guide wire so that it makes that next step, if you, that step up approach that I talked about, your kit is already designed to help you take the next step.↗
▶Ep 2 · 9:21
quoteYeah, I will completely agree with that. You're the unicorn, right? Not everybody has a unicorn.↗
▶Ep 2 · 9:37
clinicalDr. Neff uses a 12-gauge angiocath for access, which may be hard to find in pediatric hospitals but can be ordered.↗
▶Ep 2 · 9:42
clinicalThe angle of entry into the cystic ductotomy should be as flat as possible, which is why a new incision is made rather than using existing ports.↗
▶Ep 2 · 9:42
quoteWe don't use existing ports because we want our angle of entry into the cystic ductotomy to be as flat as possible.↗
▶Ep 2 · 9:57
clinicalDr. Neff uses a 6 French urethral stent cut down shorter for better flow, with a glide wire inside, using a coaxial technique to navigate the valves of Heister.↗
▶Ep 2 · 10:37
clinicalDr. Neff typically uses either a 6 millimeter or 8 millimeter angioplasty balloon, but definitely not more than that.↗
▶Ep 2 · 11:02
clinicalThe balloon dilation technique involves inflating the balloon in the duct, pulling back for tactile feedback to locate the sphincter, partially deflating, straddling the ampulla, then going to full profile under fluoroscopy and holding for about 5 minutes.↗
▶Ep 2 · 11:55
clinicalAfter balloon dilation, Dr. Neff creates a seal on the distal common duct by partially inflating a balloon straddling the cystic duct-common duct junction so that flushing through the guide wire lumen gets pressurized downstream.↗
▶Ep 2 · 12:16
clinicalIf laparoscopic common bile duct exploration is not successful, Dr. Neff places an endoloop on the cystic duct and refers to GI for ERCP.↗
▶Ep 2 · 12:16
quoteAnd you know, at that point, if, if we're not getting the job done, then we quit, you know, and we'll throw an inner loop on and, and call GIs.↗
▶Ep 2 · 12:34
epidemiologicalThe prevalence of stone disease is increasing.↗
▶Ep 2 · 12:34
quoteUh, stone disease is not going anywhere. If anything, it's, the prevalence is increasing.↗
▶Ep 2 · 13:01
quoteI think number one is getting familiar with the kit.↗
▶Ep 2 · 13:24
quoteTruly, the position of that twelve-gauge angioca is really important.↗
▶Ep 2 · 13:24
clinicalThe position of the 12-gauge angiocath is critical, and the ability to manipulate the catheter and wire in the duct depends on the initial setup and how flat the angle of entry is into the cystic duct.↗
▶Ep 2 · 13:38
clinicalThe learning curve for laparoscopic common bile duct exploration is around 5 to 10 cases, though this is person-specific.↗
Choledocholithiasis with Drs. David Vitale & Lucas Neff
▶Ep 3 · 5:17
quoteWe know the dominant paradigm across the country is an MRCP very often followed by an ERCP, but surgeons should be comfortable dealing with issues in the common bile duct, and resource utilization is a real thing.↗
▶Ep 3 · 6:42
quoteUm, so we, our mantra is all stones go forward.↗
▶Ep 3 · 7:30
quoteIf you're having to open up the common bile duct to extract the stone and you had ERCP capability, I think that that's probably in most cases, not the right thing to do.↗
▶Ep 3 · 7:45
quoteWe've created a card and actually, we want to keep this as cheap as possible, 5 or 6 French urethral stent, $7.↗
▶Ep 3 · 8:24
quoteAnd everything we do is over a guide wire so that it makes that next step, if you, that step up approach that I talked about, your kit is already designed to help you take the next step.↗
▶Ep 3 · 9:21
quoteYeah, I will completely agree with that. You're the unicorn, right? Not everybody has a unicorn.↗
▶Ep 3 · 9:37
clinicalDr. Neff uses a 12-gauge angiocath for access, which may be hard to find in pediatric hospitals but can be ordered.↗
▶Ep 3 · 9:42
clinicalThe angle of entry into the cystic ductotomy should be as flat as possible, which is why a new incision is made rather than using existing ports.↗
▶Ep 3 · 9:42
quoteWe don't use existing ports because we want our angle of entry into the cystic ductotomy to be as flat as possible.↗
▶Ep 3 · 9:57
clinicalDr. Neff uses a 6 French urethral stent cut down shorter for better flow, with a glide wire inside, using a coaxial technique to navigate the valves of Heister.↗
▶Ep 3 · 10:37
clinicalDr. Neff typically uses either a 6 millimeter or 8 millimeter angioplasty balloon, but definitely not more than that.↗
▶Ep 3 · 11:02
clinicalThe balloon dilation technique involves inflating the balloon in the duct, pulling back for tactile feedback to locate the sphincter, partially deflating, straddling the ampulla, then going to full profile under fluoroscopy and holding for about 5 minutes.↗
▶Ep 3 · 11:55
clinicalAfter balloon dilation, Dr. Neff creates a seal on the distal common duct by partially inflating a balloon straddling the cystic duct-common duct junction so that flushing through the guide wire lumen gets pressurized downstream.↗
▶Ep 3 · 12:16
clinicalIf laparoscopic common bile duct exploration is not successful, Dr. Neff places an endoloop on the cystic duct and refers to GI for ERCP.↗
▶Ep 3 · 12:16
quoteAnd you know, at that point, if, if we're not getting the job done, then we quit, you know, and we'll throw an inner loop on and, and call GIs.↗
▶Ep 3 · 12:34
quoteUh, stone disease is not going anywhere. If anything, it's, the prevalence is increasing.↗
▶Ep 3 · 12:34
epidemiologicalThe prevalence of stone disease is increasing.↗
▶Ep 3 · 13:01
quoteI think number one is getting familiar with the kit.↗
▶Ep 3 · 13:24
clinicalThe position of the 12-gauge angiocath is critical, and the ability to manipulate the catheter and wire in the duct depends on the initial setup and how flat the angle of entry is into the cystic duct.↗
▶Ep 3 · 13:24
quoteTruly, the position of that twelve-gauge angioca is really important.↗
▶Ep 3 · 13:38
clinicalThe learning curve for laparoscopic common bile duct exploration is around 5 to 10 cases, though this is person-specific.↗
quoteThis is a 16 year old. This is actually a patient of mine from about 4 months ago.↗
▶Ep 24 · 0:53
quoteThis is a 16 year old. This is actually a patient of mine from about 4 months ago.↗
▶Ep 24 · 1:13
quoteSo now we have a little bit more of a different situation with the neutropenia. Thrombocytopenic patient, what are we going to do?↗
▶Ep 24 · 1:13
quoteSo now we have a little bit more of a different situation with the neutropenia. Thrombocytopenic patient, what are we going to do?↗
▶Ep 24 · 1:31
clinicalThe patient spontaneously passed the stone, LFTs came back down, counts recovered, and he proceeded to elective cholecystectomy.↗
▶Ep 24 · 1:31
quoteAnd he spontaneously passed the stone, LFTs came back down. We were able to get him, his counts recovered and get him to elective cholecystectomy.↗
▶Ep 24 · 1:31
quoteAnd he spontaneously passed the stone, LFTs came back down. We were able to get him, his counts recovered and get him to elective cholecystectomy.↗
▶Ep 24 · 1:31
clinicalThe patient spontaneously passed the stone, LFTs came back down, counts recovered, and he proceeded to elective cholecystectomy.↗
▶Ep 24 · 2:59
opinionMost stones can be cleared, some stones pass spontaneously, and good clinical judgment with local resources must be factored into management decisions.↗
▶Ep 24 · 2:59
opinionMost stones can be cleared, some stones pass spontaneously, and good clinical judgment with local resources must be factored into management decisions.↗
▶Ep 24 · 3:01
quoteMost stones can be cleared. Some stones pass spontaneously, right? We have to use good judgment with that and local resource. You have to factor in what you have available to you.↗
▶Ep 24 · 3:01
quoteMost stones can be cleared. Some stones pass spontaneously, right? We have to use good judgment with that and local resource. You have to factor in what you have available to you.↗
clinicalGallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas.↗
▶Ep 27 · 1:39
quoteGallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage. This blockage prevents pancreatic enzymes from reaching the small intestine, leading them to accumulate and damage the pancreas.↗
▶Ep 27 · 1:39
clinicalGallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas.↗
▶Ep 27 · 1:39
quoteGallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage. This blockage prevents pancreatic enzymes from reaching the small intestine, leading them to accumulate and damage the pancreas.↗
▶Ep 27 · 2:07
opinionSome surgeons will do cholecystectomy within a few days for gallstone pancreatitis, while others will wait for a week.↗
▶Ep 27 · 2:07
opinionSome surgeons will do cholecystectomy within a few days for gallstone pancreatitis, while others will wait for a week.↗
▶Ep 27 · 2:15
quoteFrom an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, we're not jumping in to go do this case right away.↗
▶Ep 27 · 2:15
clinicalFrom an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away for gallstone pancreatitis.↗
▶Ep 27 · 2:15
clinicalFrom an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away for gallstone pancreatitis.↗
▶Ep 27 · 2:15
quoteFrom an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, we're not jumping in to go do this case right away.↗
▶Ep 27 · 2:38
quoteThere's been some studies done to show if you wait one day when the patient comes in with acute biliary pancreatitis, if the amylase lipase go up, then you do the ERCP because you have it impacted. But most of the time, it will go right down. And if it starts going down, they pass the stone and you can go to cholecystectomy.↗
▶Ep 27 · 2:38
clinicalIf amylase and lipase continue to rise one day after presentation with acute biliary pancreatitis, ERCP should be performed because the stone is likely impacted.↗
▶Ep 27 · 2:38
clinicalStudies have shown that if amylase and lipase levels go up when a patient comes in with acute biliary pancreatitis and then start going down, the stone has likely passed and the patient can proceed to cholecystectomy.↗
▶Ep 27 · 2:38
quoteThere's been some studies done to show if you wait one day when the patient comes in with acute biliary pancreatitis, if the amylase lipase go up, then you do the ERCP because you have it impacted. But most of the time, it will go right down. And if it starts going down, they pass the stone and you can go to cholecystectomy.↗
▶Ep 27 · 2:38
clinicalIf amylase and lipase continue to rise one day after presentation with acute biliary pancreatitis, ERCP should be performed because the stone is likely impacted.↗
▶Ep 27 · 2:38
clinicalStudies have shown that if amylase and lipase levels go up when a patient comes in with acute biliary pancreatitis and then start going down, the stone has likely passed and the patient can proceed to cholecystectomy.↗
Choledocholithiasis with Drs. David Vitale & Lucas Neff
▶Ep 26 · 5:17
quoteWe know the dominant paradigm across the country is an MRCP very often followed by an ERCP, but surgeons should be comfortable dealing with issues in the common bile duct, and resource utilization is a real thing.↗
▶Ep 26 · 5:17
quoteWe know the dominant paradigm across the country is an MRCP very often followed by an ERCP, but surgeons should be comfortable dealing with issues in the common bile duct, and resource utilization is a real thing.↗
▶Ep 26 · 6:42
quoteUm, so we, our mantra is all stones go forward.↗
▶Ep 26 · 6:42
quoteUm, so we, our mantra is all stones go forward.↗
▶Ep 26 · 7:30
quoteIf you're having to open up the common bile duct to extract the stone and you had ERCP capability, I think that that's probably in most cases, not the right thing to do.↗
▶Ep 26 · 7:30
quoteIf you're having to open up the common bile duct to extract the stone and you had ERCP capability, I think that that's probably in most cases, not the right thing to do.↗
▶Ep 26 · 7:45
quoteWe've created a card and actually, we want to keep this as cheap as possible, 5 or 6 French urethral stent, $7.↗
▶Ep 26 · 7:45
quoteWe've created a card and actually, we want to keep this as cheap as possible, 5 or 6 French urethral stent, $7.↗
▶Ep 26 · 8:24
quoteAnd everything we do is over a guide wire so that it makes that next step, if you, that step up approach that I talked about, your kit is already designed to help you take the next step.↗
▶Ep 26 · 8:24
quoteAnd everything we do is over a guide wire so that it makes that next step, if you, that step up approach that I talked about, your kit is already designed to help you take the next step.↗
▶Ep 26 · 9:21
quoteYeah, I will completely agree with that. You're the unicorn, right? Not everybody has a unicorn.↗
▶Ep 26 · 9:21
quoteYeah, I will completely agree with that. You're the unicorn, right? Not everybody has a unicorn.↗
▶Ep 26 · 9:37
clinicalDr. Neff uses a 12-gauge angiocath for access, which may be hard to find in pediatric hospitals but can be ordered.↗
▶Ep 26 · 9:37
clinicalDr. Neff uses a 12-gauge angiocath for access, which may be hard to find in pediatric hospitals but can be ordered.↗
▶Ep 26 · 9:42
clinicalThe angle of entry into the cystic ductotomy should be as flat as possible, which is why a new incision is made rather than using existing ports.↗
▶Ep 26 · 9:42
clinicalThe angle of entry into the cystic ductotomy should be as flat as possible, which is why a new incision is made rather than using existing ports.↗
▶Ep 26 · 9:42
quoteWe don't use existing ports because we want our angle of entry into the cystic ductotomy to be as flat as possible.↗
▶Ep 26 · 9:42
quoteWe don't use existing ports because we want our angle of entry into the cystic ductotomy to be as flat as possible.↗
▶Ep 26 · 9:57
clinicalDr. Neff uses a 6 French urethral stent cut down shorter for better flow, with a glide wire inside, using a coaxial technique to navigate the valves of Heister.↗
▶Ep 26 · 9:57
clinicalDr. Neff uses a 6 French urethral stent cut down shorter for better flow, with a glide wire inside, using a coaxial technique to navigate the valves of Heister.↗
▶Ep 26 · 10:37
clinicalDr. Neff typically uses either a 6 millimeter or 8 millimeter angioplasty balloon, but definitely not more than that.↗
▶Ep 26 · 10:37
clinicalDr. Neff typically uses either a 6 millimeter or 8 millimeter angioplasty balloon, but definitely not more than that.↗
▶Ep 26 · 11:02
clinicalThe balloon dilation technique involves inflating the balloon in the duct, pulling back for tactile feedback to locate the sphincter, partially deflating, straddling the ampulla, then going to full profile under fluoroscopy and holding for about 5 minutes.↗
▶Ep 26 · 11:02
clinicalThe balloon dilation technique involves inflating the balloon in the duct, pulling back for tactile feedback to locate the sphincter, partially deflating, straddling the ampulla, then going to full profile under fluoroscopy and holding for about 5 minutes.↗
▶Ep 26 · 11:55
clinicalAfter balloon dilation, Dr. Neff creates a seal on the distal common duct by partially inflating a balloon straddling the cystic duct-common duct junction so that flushing through the guide wire lumen gets pressurized downstream.↗
▶Ep 26 · 11:55
clinicalAfter balloon dilation, Dr. Neff creates a seal on the distal common duct by partially inflating a balloon straddling the cystic duct-common duct junction so that flushing through the guide wire lumen gets pressurized downstream.↗
▶Ep 26 · 12:16
quoteAnd you know, at that point, if, if we're not getting the job done, then we quit, you know, and we'll throw an inner loop on and, and call GIs.↗
▶Ep 26 · 12:16
quoteAnd you know, at that point, if, if we're not getting the job done, then we quit, you know, and we'll throw an inner loop on and, and call GIs.↗
▶Ep 26 · 12:16
clinicalIf laparoscopic common bile duct exploration is not successful, Dr. Neff places an endoloop on the cystic duct and refers to GI for ERCP.↗
▶Ep 26 · 12:16
clinicalIf laparoscopic common bile duct exploration is not successful, Dr. Neff places an endoloop on the cystic duct and refers to GI for ERCP.↗
▶Ep 26 · 12:34
epidemiologicalThe prevalence of stone disease is increasing.↗
▶Ep 26 · 12:34
epidemiologicalThe prevalence of stone disease is increasing.↗
▶Ep 26 · 12:34
quoteUh, stone disease is not going anywhere. If anything, it's, the prevalence is increasing.↗
▶Ep 26 · 12:34
quoteUh, stone disease is not going anywhere. If anything, it's, the prevalence is increasing.↗
▶Ep 26 · 13:01
quoteI think number one is getting familiar with the kit.↗
▶Ep 26 · 13:01
quoteI think number one is getting familiar with the kit.↗
▶Ep 26 · 13:24
clinicalThe position of the 12-gauge angiocath is critical, and the ability to manipulate the catheter and wire in the duct depends on the initial setup and how flat the angle of entry is into the cystic duct.↗
▶Ep 26 · 13:24
clinicalThe position of the 12-gauge angiocath is critical, and the ability to manipulate the catheter and wire in the duct depends on the initial setup and how flat the angle of entry is into the cystic duct.↗
▶Ep 26 · 13:24
quoteTruly, the position of that twelve-gauge angioca is really important.↗
▶Ep 26 · 13:24
quoteTruly, the position of that twelve-gauge angioca is really important.↗
▶Ep 26 · 13:38
clinicalThe learning curve for laparoscopic common bile duct exploration is around 5 to 10 cases, though this is person-specific.↗
▶Ep 26 · 13:38
clinicalThe learning curve for laparoscopic common bile duct exploration is around 5 to 10 cases, though this is person-specific.↗
