OR / Prep · Hepatobiliary Surgery · endoscopic
You’re scrubbing into
ERCP with sphincterotomy
Why are we operating?
Endoscopic drainage of the obstructed bile duct: cannulate the papilla, cut the sphincter, clear the stones, and in cholangitis, drainage beats everything else on the list.
Indication: Choledocholithiasis, ascending cholangitis, malignant obstruction for stenting; therapeutic, not diagnostic.
The operation in 4 steps
01Reaching the papilla
02Selective biliary cannulation
03Sphincterotomy and clearance
04Ensuring drainage
Danger zones
Common bile duct
The structure every biliary operation is designed not to injure; misidentification is the field's defining catastrophe.
Right hepatic artery
Crosses the triangle aberrantly in about one in seven patients, hugging the cystic duct.
Duct of Luschka
A small subvesical duct in the liver bed; missed, it declares itself as a postoperative bile leak.
Watch it done
ERCP with sphincterotomy
The endoscopic view: cannulating the papilla, the cut, and the stone coming out.
Source: Digestive Disease Center, Medical University of South Carolina · Watch on YouTubePutting the P in ERCP: pancreatic duct stenting, sphincterotomy and drainage
A teaching lecture on the pancreatic side of ERCP and the complications it is trying to avoid.
Source: Sheffield Gastroenterology · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.