Therapeutic pancreatic endoscopy

CT (A) demonstrating a large pancreatic duct stone in the head of the pancreas (arrow). Pancreatogram obtained through the minor papilla (B) demonstrates “pseudodivisum” anatomy with the ventral duct occluded by the large stone. A severe stenosis is present in the dorsal pancreatic duct which is subsequently dilated (C) using a hydrostatic balloon dilator. Two stents are placed into the dorsal pancreatic duct following ESWL and stone extraction (D).

CT scan (A) demonstrating a dilated pancreatic duct secondary to obstruction from an ampullary carcinoma and metal bile duct stent. A trans-gastric pancreatogram is obtained using endoscopic ultrasound (B) subsequent to which a guidewire is placed into the pancreatic duct (C). Transpapillary access could not be obtained using the guidewire and a trans-gastric stent was subsequently placed to decompress the pancreatic duct (D).

A large pseudocyst is seen which invades into the left lobe of the liver (A). At ERCP, a leak from the main pancreatic duct is identified (B) and stented (C). CT scan obtained several weeks later demonstrates complete resolution of the pseudocyst after transpapillary stent placement and endoscopic cystgastrostomy (D).

A small pancreatic duct stone (A) is identified on CT scan (arrow). Pancreatography demonstrates the small calculus (B) which is subsequently extracted using a stone basket (C and D).