SpyLive Cholangiopancreatoscopy Case Broadcast Schedule
Case Schedule
8:00am (CDT)
Case 1: Dilated Pancreatic Duct
The patient, a 79-year-old female, developed epigastric pain in February, for which she went to the ER. She did not have associated acute symptoms and evaluation was negative except for the CT scan of the abdomen showing a dilated pancreatic duct. She was diagnosed with diabetes mellitus in early 2019 and has lost approximately 14 pounds. Her mother died of pancreatic cancer at an advanced age. CT scan showed dilation of the main pancreatic duct to 10mm, atrophy in the tail of the pancreas, and a duct caliber change in the head. An MRI of the abdomen showed the same. EUS showed an oval mass in the head of the pancreas <2cm, a dilated MPD to 10mm, and atrophy in the proximal body and tail. FNA showed atypical epithelial cells. Cancer not be excluded.
9:00am (CDT)
Case 2: Dilated Bile Duct with Filling Defects
The patient is a 63-year-old male who was recently hospitalized for RUQ pain, acute and severe, with associated acholia and icterus. An abdominal ultrasound showed distended gallbladder but no stones, and a dilated bile duct. An MRCP showed a dilated bile duct with multiple filling defects. The patient underwent an ERCP that showed an abrupt cut-off in the distal CBD and removal of small stone fragments. A 12mm biliary sphincterotomy was performed and a 10 Fr 7cm stent placed.
10:00am (CDT)
Case 3: Dilated Hepatic Ducts
The patient, a 42-year-old female has suffered from RUQ pain for 2 years with no clear trigger. Pain is severe, sharp and intermittent and it radiates to the back. She had a remote laparoscopic cholecystectomy complicated with a bile leak, which was corrected surgically. LFTs were significant for an alkaline phosphatase of 474, ALT 64 and AST 62. Serologic studies for underlying liver disease were negative. MRCP showed dilatation of the LHD and RHD just above the hilum.
11:00am (CDT)
Case 4: Complex Hepatic Duct Stone
A 23-year-old female patient presented with RUQ pain and abnormal LFTs and was found to have recurrent choledocholithiasis. She had an initial ERCP in 2012 at which time she had stone clearance using standard methods. She had another ERCP in May 2019, at which time a sphincterotomy was performed—sphincteroplasty to 11mm, and mechanical lithotripsy—but efforts to capture the stone were unsuccessful. During the same procedure, cholangioscopy-guided EHL was performed but unable to fragment a 15mm stone, located in the CHD.
12:00pm (CDT)
Case 5: Chronic Pancreatitis and Pancreatic Duct Stones
The patient is a 55-year-old female with a history of chronic pancreatitis of uncertain etiology and is a heavy smoker. She underwent a CT scan of the abdomen to evaluate recently developed epigastric pain that showed diffuse dilatation of the ventral pancreatic duct, more pronounced in the tail of the pancreas. An EUS was performed in April 2019 that showed chronic pancreatitis, and a pancreatic duct of 8mm with intraductal stones.
1:00pm (CDT)
Case 6: Intrahepatic Biliary Ductal Irregularity
The patient, a 23-year-old female, is experiencing jaundice and worsening LFTs. She is known to have PSC. An MRI MRCP performed on June 7, 2019 showed diffuse intrahepatic biliary ductal irregularity, T1 hyperintense filling defects in the right and left hepatic ducts, and a non-dilated CBD. She has evidence of portal hypertension but has a patent portal vein. No evidence of mass. Patient is symptomatic with RUQ pain and jaundice.
2:00pm (CDT)
Case 7: Intrahepatic Biliary Dilation and Intrahepatic Duct Filling Defect
The patient is a 50-year-old female who underwent a laparoscopic cholecystectomy 3 years prior for biliary dyskinesia. She developed severe epigastric pain in March 2019 that required hospitalization. She was found to have elevated LFTs (TB 4.4, alkaline phosphatase 281, AST 185 and LAT 346) and a CT of the abdomen showed minimal pancreatic head edema and mild intrahepatic and extrahepatic biliary duct dilatation. She was treated for acute pancreatitis. She has not had any previous episodes nor risk-factors for pancreatitis. An EUS was performed on June 14, 2019 and showed intrahepatic biliary dilatation and a non-echo-shadowing filling defect in the left IHD. The extrahepatic duct was mildly dilated, and the pancreas was normal.
