WEO Video: Dr. Horst Neuhaus
Dr. Horst Neuhaus performs a single operator direct peroral cholangioscopy
Dr. Horst Neuhaus from the Center of Excellence in Düsseldorf, Germany is performing a direct peroral cholangioscopy (DPOC) during the annual meeting of the Center of Excellence in Kuala Lumpur, Malaysia, on the service of Dr. KL Goh. The patient had a hilar stricture which was indeterminate, and plastic stents had been used to bridge the stricture to relieve obstructive jaundice. Dr. Neuhaus removed the stents and during ERCP placed a wire across the stricture. A special anchoring balloon (Cook, Inc.) was placed over the wire (the balloon has a small loop at its tip to facilitate following the wire) into the proximal biliary tree. The 15 mm balloon is then inflated and the inflating syringe and connectors are removed, but the balloon remains inflated. The duodenoscope is removed but the inflated balloon and long catheter remain in place like a nasobiliary probe. An ultrathin (transnasal) gastroscope is then backloaded over the catheter and using it as a guide, is advanced to the stricture and beyond. This technique only requires one endoscopist, there is no need for a separate video processor. The diameter of the working channel through this instrument is 2 mm which provides a wide range of accessories for diagnostic and therapeutic options which can be placed through the slim transnasal gastroscope. Imaging is excellent and narrow band imaging is available. Dr. Neuhaus found that the stricture was malignant as proven on biopsy.
This procedure was performed by Dr. Horst Neuhaus from Germany during the annual meeting of the Center of Excellence in Kuala Lumpur, Malaysia, on the service of Dr. KL Goh.
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