nature publishing group
the red section
Video of the Month Am J Gastroenterol 2014;109:21; doi:10.1038/ajg.2013.446
Multimodality endoscopic retrograde cholangiopancreatography in Billroth II anatomy. In a Billroth II (BII) reconstruction, following resection of the antrum and pylorus, a limb of jejunum is anastomosed to the body of the stomach. The BII creates an afferent limb, through which the biliary and pancreatic drainage continues through the native papilla, and an efferent, or downstream, limb. After a BII reconstruction, the papilla has a mirror-image configuration of its original form, and the bile duct therefore courses in the 5-o’clock direction rather than the typical 11-o’clock direction. This difference usually makes it impossible to perform biliary sphincterotomy with a standard pull-type sphincterotome. In this video we demonstrate the use of multiple modalities to achieve endoscopic sphincterotomy and extraction of a large common-bile-duct stone. (Submitted by Nisa Kubiliun, University of Texas Southwestern Medical Center, Dallas, Texas, and B. Joseph Elmunzer, University of Michigan, Ann Arbor, Michigan.)
To watch the Video of the Month, please visit AJG online: http://www.nature.com/ajg/journal/v109/n1/suppinfo/ajg2013446s1.html
© 2014 by the American College of Gastroenterology
The American Journal of Gastroenterology
21
the red section
Video of the Month Am J Gastroenterol 2014;109:21; doi:10.1038/ajg.2013.446
Multimodality endoscopic retrograde cholangiopancreatography in Billroth II anatomy. In a Billroth II (BII) reconstruction, following resection of the antrum and pylorus, a limb of jejunum is anastomosed to the body of the stomach. The BII creates an afferent limb, through which the biliary and pancreatic drainage continues through the native papilla, and an efferent, or downstream, limb. After a BII reconstruction, the papilla has a mirror-image configuration of its original form, and the bile duct therefore courses in the 5-o’clock direction rather than the typical 11-o’clock direction. This difference usually makes it impossible to perform biliary sphincterotomy with a standard pull-type sphincterotome. In this video we demonstrate the use of multiple modalities to achieve endoscopic sphincterotomy and extraction of a large common-bile-duct stone. (Submitted by Nisa Kubiliun, University of Texas Southwestern Medical Center, Dallas, Texas, and B. Joseph Elmunzer, University of Michigan, Ann Arbor, Michigan.)
To watch the Video of the Month, please visit AJG online: http://www.nature.com/ajg/journal/v109/n1/suppinfo/ajg2013446s1.html
© 2014 by the American College of Gastroenterology
The American Journal of Gastroenterology
21
