By Peter B. Cotton
Complicated Digestive Endoscopy: ERCP addresses probably the most advanced diagnostic and healing tactics for endoscopists. It offers the newest considering and transparent guideline at the options, that have been built-in with total sufferer care. Written by way of the prime overseas names in endoscopy, the textual content has been expertly edited via Peter Cotton right into a succinct, instructive layout. provided briefly paragraphs based with headings, subheadings and bullet issues and richly illustrated all through with full-color pictures
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The scope is adjusted so that the papilla is in the central position. If the cannula is seen coming from below pointing towards the right or the anterior wall of the CBD, withdraw the cannula and relax the upward angulation of the scope. The direction or axis of the cannula can be altered by pulling back the scope until the curve of the cannula is in line with the axis of the CBD. Slight left angulation of the tip of the scope may help to slide the tip of the cannula into the CBD. FUNDAMENTALS OF ERCP Manipulation is best performed with intermittent injection of contrast to outline the direction/axis of the CBD on ﬂuoroscopy.
The scope is angled downwards again and air is insufﬂated to distend the duodenum. Care must be taken to avoid overinﬂating the duodenum as this causes patient discomfort and makes the procedure more difﬁcult. Careful examination is performed to rule out any pathologies such as ulcers or duodenitis. The scope is pushed further to the junction of the ﬁrst and second part of the duodenum. At this point, the scope is angled to the right and upwards, and by rotating the scope to the right and withdrawing slowly, the tip of the scope is advanced into the second part of the duodenum.
12). Failure to ﬁll the gallbladder despite adequate ﬁlling of the intrahepatic ducts suggests cystic duct obstruction. Stone impaction in the FUNDAMENTALS OF ERCP cystic duct may cause edema and compression of the common hepatic duct giving rise to Mirizzi’s syndrome. Underﬁlling and delayed drainage With an adequate intrahepatic cholangiogram, underlying parenchymal liver diseases may be inferred from abnormal appearance of the intrahepatic ducts. Crowding of tortuous intrahepatic ducts may suggest liver cirrhosis.
Advanced digestive endoscopy : ERCP by Peter B. Cotton