Question Help with possible ERCP?


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Hello All,

I'm in need of some help. My research did not pull up anything close to this scenario and I'm at a loss as to how to code this.

The lubricated Olympus endoscope was inserted transorally and advanced under direct visualization to the jejunum. There was evidence of previous gastrectomy with gastrojejunostomy, Bilroth II. Afferent limp revealed significant inflammation with ulceration, but no stones. There was some edema and acutely inflamed mucosa and this are was not probed any further to prevent any perforation. The scope was withdrawn and reinserted through the efferent limb, where a large impacted stone was encountered. Multiple attempts were made at removal of the stone. Initially used rat-tooth forceps to cut into the stone with some success, but the core of the stone was too hard. A rothnet was attempted as well, and only small pieces of stone could be removed. I used the mechanical lithotrispy to try and crush the stone without success, as well. Small fragments of the stone were removed and the impaction relieved. I could get to the side of the stone, but could not go fully to the distal edge of the stone. The stone was too hard and large to be removed by any of the instruments available to me. The scope was withdrawn.


Any help would be great.