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- W2334784041 abstract "Lack of mechanical advantage may be the limiting factor to successful endoscopic stent placement. This is particularly true when traversing tight biliary or pancreatic strictures or when placing more than one stent across such a stricture. Various methods have been recommended to remedy this, e.g., positioning the duodenoscope in a short gastric position by using stiffer guidewires, narrower stents. A prototype duodenal-bulb balloon has been described that will partially fill the duodenal sweep lumen to maintain a duodenoscope position closer to the major papilla while pushing the stent up the duct.1Jamidar P. Hawes R. Leman G. Use of an ERCP stabilizing balloon to achieve catheter placement and dilation of high-grade biliary strictures.Gastrointest Endosc. 1994; 40: 354-356Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Perhaps a simpler first step to provide additional mechanical advantage, when necessary, is to have the endoscopic assistant apply firm pressure just below the epigastrium, pushing in a cephalad direction. We use the term “pancreaticobiliary Heimlich maneuver,” to refer to this. It prevents the duodenoscope from sliding backward, away from the papilla, during stent deployment. (A similar technique traditionally has been used during colonoscopy to prevent sigmoid alpha loop formation.) The improved mechanical advantage may, at times, be quite dramatic. Real-time fluoroscopy must be suspended while the assistant's hand is in the field; however, this has not proven to be a significant disadvantage. The technique also is useful during intubation of the duodenum in patients with a dilated or atonic stomach. We have not noted any increased procedure morbidity nor any increased patient recall of increased procedure-related discomfort." @default.
- W2334784041 created "2016-06-24" @default.
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- W2334784041 date "2006-01-01" @default.
- W2334784041 modified "2023-09-27" @default.
- W2334784041 title "Pancreaticobiliary Heimlich maneuver to facilitate stent placement during ERCP" @default.
- W2334784041 cites W2061315826 @default.
- W2334784041 doi "https://doi.org/10.1016/j.gie.2005.07.044" @default.
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