By Peter B. Cotton
Complex Digestive Endoscopy: ERCP addresses the most complicated diagnostic and healing techniques for endoscopists. It presents the most recent considering and transparent guideline at the recommendations, that have been built-in with total sufferer care. Written by way of the best foreign names in endoscopy, the textual content has been expertly edited by means of Peter Cotton right into a succinct, instructive layout. provided in brief paragraphs dependent with headings, subheadings and bullet issues and richly illustrated all through with full-color pictures
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Extra info for Advanced digestive endoscopy : ERCP
Space should be available for anesthetic support and resuscitation equipment when needed. Ideally, there should be no cables or tubing on the ﬂoor that may hinder movement of carts or 19 20 CHAPTER 3 Fig. 2 Space for endoscopist and trainee or assistant. Accessories organized and within easy reach of endoscopist. trolleys. Accessories should be organized and stored to facilitate easy retrieval during procedures. Position of monitors and endoscopy cart (Fig. 2) Some units have the endoscopy monitor mounted on the endoscopy cart at the head of the patient, which means the endoscopist has to turn to the right, away from the patient, in order to observe the endoscopy image.
Manometric studies are necessary to conﬁrm the diagnosis in patients without obvious duct dilation or liver test abnormalities. Bile leaks and ﬁstulas complicating biliary tract surgery can be readily identiﬁed on cholangiography. 2 mm channel. All of these scopes readily accept a 5 Fr or 6 Fr catheter and accessories. 5 Fr diameter and are used for both diagnostic and therapeutic purposes. The larger instrument channel allows aspiration of duodenal contents even with an accessory in place, and also permits the manipulation of two guidewires or accessories simultaneously.
If no obvious ﬂow of pancreatic juice is observed at the minor papilla after injection of secretin, it is wise to re-examine the main papilla. A good ﬂow of pancreatic juice at the main papilla suggests that the patient does not have pancreas divisum and further cannulation attempts should be made at the main papilla. Failure to obtain deep CBD cannulation This usually results from a failure to align with the correct axis of the bile duct. Pushing the tip of the cannula may distort the papilla.