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Gastroenterology


Answer 3
  1. Endoscopic retrograde cholangiopancreatography. The patient has an obstructed biliary tree and needs to undergo decompression. Endoscopic retrograde cholangiopancreatography allows nonsurgical access to the biliary tree, bile drainage, and stone removal. Endoscopic ultrasound and magnetic resonance cholangiography are purely diagnostic in this setting. Either one would likely only confirm the presence of a retained CBD stone and would not change the patient’s overall management. A percutaneous transhepatic cholangiography approach to decompress the biliary tree can be attempted if endoscopic retrograde cholangiopancreatography is unsuccessful, but this option is not first-line treatment for patients in this situation. Intraoperative bile duct exploration would not be attempted in this setting because it is too invasive compared with endoscopic retrograde cholangiopancreatography.

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