Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 41: A 56-Year-Old Female With Nausea And Vomiting Has A Mildly Elevated Bilirubin But Normal Amylase And Lipase. Ct Shows Thickening Of The Duodenum And Mildly Dilated Cbd. Attempted Ercp Shows A Tight Ulcerative Stenosis Of 1St/2Nd Part Of The Duodenum. What Should I Do? (continued)

Todd H. Baron, MD, FASGE

This clinical scenario described is both interesting and challenging. First, you need to determine the diagnosis; second, provide treatment. At the present time, you do not need to be concerned about relief of biliary obstruction, given the lack of cholangitis and pruritus. The differential diagnosis includes inflammatory, neoplastic, and infectious etiologies. All of these processes can penetrate into and through the medial wall of the duodenum and surround the distal bile duct with the resultant thickening of the duodenum and biliary obstruction seen on computed tomography (CT)…