INTRODUCTION ERCP in seriously ill patients consists of a challenge in invasive Gastroenterology
due to the fact that it is mainly performed under intubation-general anesthesia with
the potential respiratory and other risks.
AIM We present a patient suffering from suppurative cholangitis who underwent ERCP
with the use of a specialized laryngeal mask.
METHOD A 98-years old female patient with a history of CAD, DM II, COPD, NYHA III
heart failure under dual-antiplatelet therapy has been hospitalised due to suppurative
cholangitis complicated by Systemic Inflammatory Response Syndrome (SIRS). She underwent
cross-imaging (CT/MRI) which revealed an impacted common bile duct and an ERCP was
scheduled. Given the increased risk of post-ERCP respiratory complications, it was
decided to apply deep sedation with the use of a specialized laryngeal maskwith an
integrated endoscope channel instead of general anesthesia. The common bile duct was
drained with the use of a plastic stent. A few days later after satisfactory clinical
improvement the patient underwent a second 'regular' ERCP where the bile duct stone
was completely removed uneventfully.
CONCLUSION The use of a specialized laryngeal mask with an integrated endoscope channel
during ERCP in seriously ill patients could be a safe and effective alternative treatment
for avoidance of intubation and its potential complications.
