Gastro liver centre bahria town international hospital lahore

17/12/2024

Second part of duodenum accessed. Ampulla identified. Previously placed blocked stents seen in situ in CBD.Previously placed stents removed. After cannulation of ampulla, Selective cannulation of CBD done. Guide wire passed in CBD. Guide wire passed in anterior and posterior sectoral ducts. Contrast injected. Previous site of anastomotic stricture at the anterior and posterior sectoral ducts seen sufficiently dilated. Stricture site dilated with Biliary CRE balloon 8mm. Stricture seen sufficiently dilated on occlusion cholangiogram. Balloon trawling of CBD done with biliary stone extraction balloon. Copious amounts of pus retrived.Free flow of bile seen. Patient tolerated the procedure well. No immediate complications seen

14/12/2024

ESOPHAGUS
Normal upper and middle third. Lower third showing a short column of
Grade I varix.
STOMACH
Normal body and fundus.
No fundal varix seen.
Multiple telengiectasias seen in the antrum.
Argon Plasma Coagulation (APC) done and hemostasis secured.
Normal pylorus.
DUODENUM
Normal duodenal bulb

14/12/2024

ESOPHAGUS
Normal upper and middle third. Distal third normal.
STOMACH
Normal fundus.
Normal body.
Mild Antral gastritis seen in antrum.
Normal pylorus.
DUODENUM
Normal duodenal bulb.
One stent seen in situ in second part of duodenum. Stent removed with the help of biopsy forceps.

14/12/2024

DUODENUM Normal bulb .
Normal Distal Duodenum.
GASTRIC BALLOON PLACEMENT
Gastric Balloon seen in situ in the gastric body under direct and endoscopic vision. Balloon deflated completely. 700 ml of fluid removed. Balloon removed from the stomach. Patient tolerated the procedure well

14/12/2024

ESOPHAGUS
Normal Upper and middle third. Lower third showing 2 columns of Grade
II varices.2 bands applied
STOMACH
Mild Portal hypertensive Gastropathy seen in body and fundus.
Edematous mucosal fold seen near the fundus.
Mild Portal hypertensive gastropathy seen in the antrum.
Normal pylorus

14/12/2024

Appropriate site for PEG insertion selected under direct and endoscopic control. 24 F pull type PEG tube placed under direct and endoscopic control . ASD Done

14/12/2024

Second part of duodenum accessed. Normal looking Ampulla identified. Previously placed stent seen in situ in CBD. Cannulation of CBD done. Guide wire passed in CBD. Contrast injected. Cholangiogram showing prominent CBD with extravasation of dye seen at the level of the common hepatic duct. Right hepatic system engaged. A 10FX12cm stent placed in the right hepatic duct. Free flow of bile seen

14/12/2024

Second part of duodenum accessed, Ampulla identified. Cannulation of CBD done. Guide wire passed in CBD. Contrast injected. Cholangiogram showing dilated CBD with a filling defect in the distal end of CBD with prominent intrahepatic biliary channels.Sphincterotomy done.CBD swept with stone extraction balloon multiple times. Stone retrieved. A 10FX10cm stent placed in the CBD.Free flow of bile seen

24/11/2024