Scot M. Lewey, DO, FACG, FASGE, AGAF
Clinical Professor of Medicine
This endoscopic photo is of the duodenal papilla or ampula of Vater. Out of the papilla drains bile from the liver and pancreatic enzymes from the pancreas. This papilla has been "cut" or undergone sphincterotomy to allow better access to place a stent.
This image demonstrates cannulation of the papilla and bile duct during ERCP.
These two images show a papilla or Ampula of Vater that has been "cut" or undergone a sphincterotomy; subsequent is cannulation of papilla and bile duct.
This image shows a guidewire in the papilla that has accessed the bile duct and will serve as a guide to passage of a balloon catheter allowing sweeping of the duct and/or placement of a temporary or permanent biliary stent.
This image shows an inflated balloon biliary catheter that can sweep the bile duct to remove retained stones.
A guide wire can be placed in the bile duct to allow access for additional maneuvers, such as balloon sweeps, obtain brushing samples, or placement of biliary stents. A balloon catheter can be passed into the bile duct with the balloon deflated, then once the catheter is pushed up the bile duct, the balloon can be inflated and pulled down the bile duct dragging out any retained stones.
The papilla has a temporary biliary stent placed allowing drainage of the bile duct.
This image shows a temporary biliary stent that has partially migrated out the papilla. It is still draining bile. This stent was removed before placement of a permanent metal stent for palliation of incurable pancreatic cancer.
This pair of images here show temporary biliary stents in the papilla allowing drainage of bile out of the bile duct. The stent on the left is placed deeply, with only a flap extruding. The one on the right has migrated partially out of the bile duct. It was removed to allow place a permanent metal stent in a patient with incurable pancreatic cancer whose bile duct needs to be kept open to allow drainage since the patient is not a candidate for curative surgery of the pancreatic tumor.
This image shows a well placed coated permanent stent in bile duct to provide drainage and prevent obstruction in a patient with pancreatic cancer that is not operable.
Another view of successfully placed metal stent in the bile duct.
This pair of images demonstrates what a metal stent looks like in the papilla providing drainage of the bile duct in patient with cancerous obstruction of the bile duct (pancreatic cancer in this case).
This is a relatively small sessile precancerous colon polyp.
This is how the precancerous colon polyp looks under a special light called narrow band imaging.
The above two photos are of the same polyp, the picture on the left was taken with standard light endoscopy, the one on the right is taken after switching the light wave to narrow band imaging (NBI) mode. This feature available on the newer endoscopes adds greater detail to the image that can help assess if a polyp, growth or lesion may be cancerous of precancer in nature.
The above photos are of benign precancerous polyps under the microscope. Both are tubular adenomas. There are redundant foldings of colon glandular cells. Compared to colon cancer, the glandular cells are still organized and have normal nuclei. Cancer cells rebel and expand, invade and have "angry" enlarged and much darker nuclei. An example of colon cancer under the microscope is below.