David Vitale
67 statements · 5 topics · summaries given as host listed separately
Featured statements
I think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.
quote ·
Choledocholithiasis
When things are improving, we don't need to see biochemical normalization. But when the symptoms are improving, we go right to cholecystectomy with intraoperative cholangiogram and coordinate with you just in case there might be a need for an ERCP.
quote ·
ALL
We know that there are metabolic risk factors, uh, hemolysis such as sickle cell, congenital and biliary anomalies like colloidal cysts.
quote ·
Choledocholithiasis
According to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP.
guideline ·
Sarcoma (Ewing/Rhabdo)
Studies show that if you wait one day when a patient comes in with acute biliary pancreatitis and the amylase/lipase go up, then you do ERCP because the stone is impacted; but most of the time the levels will go right down as the stone passes spontaneously, and you can proceed to cholecystectomy.
clinical ·
ALL
The pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL.
clinical ·
Sarcoma (Ewing/Rhabdo)
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David's statements about ALL 9 statements
Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
Statement
Studies show that if you wait one day when a patient comes in with acute biliary pancreatitis and the amylase/lipase go up, then you do ERCP because the stone is impacted; but most of the time the levels will go right down as the stone passes spontaneously, and you can proceed to cholecystectomy.
Open
Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
Quotation
This patient, currently undergoing treatment for acute lymphoblastic leukemia, or ALL, presents with right upper quadrant pain. He's neutropenic, has markedly elevated liver function tests, and ultrasound findings are consistent with acute cholecystitis and cholecystitis.
Open
Statement
A 16-year-old male with acute lymphoblastic leukemia (ALL), neutropenic and thrombocytopenic, presented with right upper quadrant pain, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis.
Open
Statement
Over 50% of the live and virtual audience poll opted to start antibiotics and address the elevated liver function tests in the neutropenic thrombocytopenic patient.
Open
Statement
Dr. Neff's patient spontaneously passed the stone, LFTs came back down, counts recovered, and the patient proceeded to elective cholecystectomy.
Open
Statement
When symptoms are improving in gallstone pancreatitis, cholecystectomy with intraoperative cholangiogram can proceed without waiting for biochemical normalization, coordinating with ERCP availability if needed.
Open
Quotation
When things are improving, we don't need to see biochemical normalization. But when the symptoms are improving, we go right to cholecystectomy with intraoperative cholangiogram and coordinate with you just in case there might be a need for an ERCP.
Open
Statement
Most biliary stones can be cleared, and some stones pass spontaneously, requiring good clinical judgment.
Open
Statement
Local resources and what is available must be factored into management decisions for biliary stones.
Open
David's statements about Choledocholithiasis 11 statements
Open the Choledocholithiasis collection →
Choledocholithiasis with Drs. David Vitale & Lucas Neff
Quotation
We know that there are metabolic risk factors, uh, hemolysis such as sickle cell, congenital and biliary anomalies like colloidal cysts.
Open
Statement
Risk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts.
Open
Statement
Choledocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity.
Open
Quotation
This slide is actually taken from ASGE, uh, which is the Adult Endoscopy Society for GI.
Open
Statement
Retrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise.
Open
Quotation
I really think again it gets back to institution dependent expertise and it's probably provider dependent and the institution's experience with this.
Open
Statement
Stones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult.
Open
Quotation
I think, uh, local expertise and availability is probably the most important thing in this decision tree.
Open
Statement
Local expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration.
Open
Statement
Never use a balloon larger than the dilated common bile duct, as adult literature shows higher rates of pancreatitis with ampullary dilation without sphincterotomy.
Open
Quotation
I think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.
Open
David's statements about Cholelithiasis 11 statements
Open the Cholelithiasis collection →
Choledocholithiasis with Drs. David Vitale & Lucas Neff
Statement
Risk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts.
Open
Quotation
We know that there are metabolic risk factors, uh, hemolysis such as sickle cell, congenital and biliary anomalies like colloidal cysts.
Open
Statement
Choledocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity.
Open
Quotation
This slide is actually taken from ASGE, uh, which is the Adult Endoscopy Society for GI.
Open
Statement
Retrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise.
Open
Quotation
I really think again it gets back to institution dependent expertise and it's probably provider dependent and the institution's experience with this.
Open
Statement
Stones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult.
Open
Quotation
I think, uh, local expertise and availability is probably the most important thing in this decision tree.
Open
Statement
Local expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration.
Open
Statement
Never use a balloon larger than the dilated common bile duct, as adult literature shows higher rates of pancreatitis with ampullary dilation without sphincterotomy.
Open
Quotation
I think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.
Open
David's statements about Pancreatitis 10 statements
Open the Pancreatitis collection →
Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
Statement
Studies show that if you wait one day when a patient comes in with acute biliary pancreatitis and the amylase/lipase go up, then you do ERCP because the stone is impacted; but most of the time the levels will go right down as the stone passes spontaneously, and you can proceed to cholecystectomy.
Open
Statement
Studies show that if you wait one day when a patient comes in with acute biliary pancreatitis and the amylase/lipase go up, then you do ERCP because the stone is impacted; but most of the time the levels will go right down as the stone passes spontaneously, and you can proceed to cholecystectomy.
Open
Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
Statement
A 16-year-old male with acute lymphoblastic leukemia (ALL), neutropenic and thrombocytopenic, presented with right upper quadrant pain, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis.
Open
Quotation
This patient, currently undergoing treatment for acute lymphoblastic leukemia, or ALL, presents with right upper quadrant pain. He's neutropenic, has markedly elevated liver function tests, and ultrasound findings are consistent with acute cholecystitis and cholecystitis.
Open
Statement
Over 50% of the live and virtual audience poll opted to start antibiotics and address the elevated liver function tests in the neutropenic thrombocytopenic patient.
Open
Statement
Dr. Neff's patient spontaneously passed the stone, LFTs came back down, counts recovered, and the patient proceeded to elective cholecystectomy.
Open
Quotation
When things are improving, we don't need to see biochemical normalization. But when the symptoms are improving, we go right to cholecystectomy with intraoperative cholangiogram and coordinate with you just in case there might be a need for an ERCP.
Open
Statement
When symptoms are improving in gallstone pancreatitis, cholecystectomy with intraoperative cholangiogram can proceed without waiting for biochemical normalization, coordinating with ERCP availability if needed.
Open
Statement
Most biliary stones can be cleared, and some stones pass spontaneously, requiring good clinical judgment.
Open
Statement
Local resources and what is available must be factored into management decisions for biliary stones.
Open
David's statements about Sarcoma (Ewing/Rhabdo) 26 statements
Open the Sarcoma (Ewing/Rhabdo) collection →
Choledocholithiasis with Drs. David Vitale & Lucas Neff
Quotation
We know that there are metabolic risk factors, uh, hemolysis such as sickle cell, congenital and biliary anomalies like colloidal cysts.
Open
Quotation
We know that there are metabolic risk factors, uh, hemolysis such as sickle cell, congenital and biliary anomalies like colloidal cysts.
Open
Statement
Risk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts.
Open
Statement
Risk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts.
Open
Statement
Choledocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity.
Open
Statement
Choledocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity.
Open
Statement
According to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP.
Open
Quotation
This slide is actually taken from ASGE, uh, which is the Adult Endoscopy Society for GI.
Open
Quotation
This slide is actually taken from ASGE, uh, which is the Adult Endoscopy Society for GI.
Open
Statement
In pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones.
Open
Statement
The pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL.
Open
Statement
Pediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay.
Open
Statement
Retrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise.
Open
Statement
Retrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise.
Open
Quotation
I really think again it gets back to institution dependent expertise and it's probably provider dependent and the institution's experience with this.
Open
Quotation
I really think again it gets back to institution dependent expertise and it's probably provider dependent and the institution's experience with this.
Open
Statement
Stones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult.
Open
Statement
Stones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult.
Open
Quotation
I think, uh, local expertise and availability is probably the most important thing in this decision tree.
Open
Quotation
I think, uh, local expertise and availability is probably the most important thing in this decision tree.
Open
Statement
Local expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration.
Open
Statement
Local expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration.
Open
Statement
Never use a balloon larger than the dilated common bile duct, as adult literature shows higher rates of pancreatitis with ampullary dilation without sphincterotomy.
Open
Quotation
I think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.
Open
Quotation
I think your point there, uh, never use a balloon that's larger than the dilated comet bile duct, which is really important, uh, cause we know that there is some USP literature out there with people looking at, uh, doing dilations of the ampula without doing a sphincterotomy, and there's definitely a higher rate of pancreatitis in those patients.
Open
Statement
Never use a balloon larger than the dilated common bile duct, as adult literature shows higher rates of pancreatitis with ampullary dilation without sphincterotomy.
Open
Summaries David gave as host · 12 summaries
Recaps of other experts' statements, not David's own clinical position.
Summaries David gave as host · Choledocholithiasis 4 summaries
Open the Choledocholithiasis collection →
Choledocholithiasis with Drs. David Vitale & Lucas Neff
Host summary
David Vitale summarizes what Dr. Luke Neff said: According to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP.
Open
Host summary
David Vitale summarizes what Dr. Luke Neff said: In pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones.
Open
Host summary
David Vitale summarizes what Dr. Luke Neff said: The pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL.
Open
Host summary
David Vitale summarizes what Dr. Luke Neff said: Pediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay.
Open
Summaries David gave as host · Cholelithiasis 4 summaries
Open the Cholelithiasis collection →
Choledocholithiasis with Drs. David Vitale & Lucas Neff
Host summary
David Vitale summarizes what Dr. Luke Neff said: According to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP.
Open
Host summary
David Vitale summarizes what Dr. Luke Neff said: In pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones.
Open
Host summary
David Vitale summarizes what Dr. Luke Neff said: The pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL.
Open
Host summary
David Vitale summarizes what Dr. Luke Neff said: Pediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay.
Open
Summaries David gave as host · Sarcoma (Ewing/Rhabdo) 4 summaries
Open the Sarcoma (Ewing/Rhabdo) collection →
Choledocholithiasis with Drs. David Vitale & Lucas Neff
Host summary
David Vitale summarizes what Dr. Luke Neff said: According to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP.
Open
Host summary
David Vitale summarizes what Dr. Luke Neff said: In pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones.
Open
Host summary
David Vitale summarizes what Dr. Luke Neff said: The pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL.
Open
Host summary
David Vitale summarizes what Dr. Luke Neff said: Pediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay.
Open