Handling tight bile duct strictures, drain upsizing methods, and adding side holes to drains

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Lesson 9 • 12 Mar 2025

Handling tight bile duct strictures, drain upsizing methods, and adding side holes to drains

with Dr. Ahsun Riaz, Dr. Christopher Beck

Course overview

Learn the principles, techniques, and advancements with biliary interventions, encompassing both established practices and multidisciplinary approaches. The course covers approaches to internal-external biliary drains (PTBD) for benign and malignant obstructions, as well as dilated and non-dilated systems.

1.5 hours, 31 lessons

Lessons

Biliary Drain Placement (PTBD)

Lesson 1

Indications, sedation vs. anesthesia, and GI vs. IR approaches for biliary interventions

Lesson 2

Techniques for accessing a dilated biliary system, focusing on right-sided percutaneous access

Lesson 3

Steps for initial needle stick, injecting contrast, and identifying biliary ducts

Lesson 4

Two-stick technique and triangulating for bile duct access in PTC procedures

Lesson 5

Challenges and techniques for handling non-dilated biliary collecting systems in PTC procedures

Lesson 6

Adjusting needle approach for bile duct access and handling post-operative leaks

Lesson 7

Managing biliary obstructions, including decision-making based on malignancy, surgery, and patient condition

Lesson 8

Approaches for wire placement, drainage, and biopsies in malignant CBD strictures

Lesson 9

Handling tight bile duct strictures, drain upsizing methods, and adding side holes to drains

Lesson 10

Clinical management of distal CBD stones and protocols for benign biliary strictures

Lesson 11

Internal stents for terminal patients and patient comfort

Multidisciplinary approach to benign & malignant biliary disease

Lesson 12

Referral sources, patient workup, and preferred imaging techniques for hepatobiliary surgery

Lesson 13

Collaboration between interventional radiologists and surgeons in treating biliary disease

Lesson 14

Patient referrals and multidisciplinary approaches in interventional radiology and surgery

Lesson 15

Thinking beyond the specialty for patient-centered solutions

Lesson 16

Patient scenarios, decision-making, and local expertise in treating benign biliary diseases

Lesson 17

Patient selection for surgery or alternative treatments in malignant liver conditions

Lesson 18

Drainage types, and the importance of patient preferences

Lesson 19

Advanced interventional techniques, patient risks, and decision-making in GI and IR

Lesson 20

Palliative drainage, stenting approaches, and preferences in biliary obstruction management

Lesson 21

Managing cholecystitis due to covered stents

Lesson 22

Complications from pancreatic duct obstruction in pancreatic tumors

Lesson 23

Consider goals, patient disposition, and symptomatology when determining the number of biliary drains

Lesson 24

Resolving conflicts on patient care decisions between surgeons and interventionalists

Lesson 25

Weighing the risk vs benefit of placing drains through tumors

Cholecystomy Tubes

Lesson 26

Referral sources, emergency procedures, imaging, and labs for high-risk cholecystectomy cases

Lesson 27

Approaches to tube placement in septic patients on anticoagulation

Lesson 28

Pros and Cons of using CT versus ultrasound and fluoroscopy for gallbladder procedures

Lesson 29

Tube insertion efficiency, pain management, and needle preferences

Lesson 30

Techniques and preferences for tube placement, including selecting tube sizes

Lesson 31

Pros and cons of using gravity bags versus JP bulbs for drainage

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