By Peter B. Cotton
Complex Digestive Endoscopy: ERCP addresses one of the most advanced diagnostic and healing tactics for endoscopists. It presents the most recent pondering and transparent guide at the strategies, which were built-in with total sufferer care. Written by means of the best overseas names in endoscopy, the textual content has been expertly edited by means of Peter Cotton right into a succinct, instructive layout. offered briefly paragraphs based with headings, subheadings and bullet issues and richly illustrated all through with full-color photos
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Additional info for Advanced digestive endoscopy : ERCP
Passage of the guidewire into the pancreatic duct can be easily identiﬁed on ﬂuoroscopy. When the guidewire and catheter (or sphincterotome) are inserted into the bile duct, the wire is then removed and bile is aspirated back into the catheter to conﬁrm the position before contrast is injected to outline the biliary system. The use of tapered tip cannulas and precut sphincterotomy increases the risk of submucosal injection and perforation, especially when performed by inexperienced endoscopists.
A lead collar should be worn to protect the thyroid gland, and lead glasses are recommended, especially if a ﬂuoroscopy unit with an over-couch tube is 27 28 CHAPTER 3 used. Individuals should also wear their X-ray badge on the outside for monitoring purposes. It is necessary to use external lead shielding of the reproductive organs for young or female patients. Other protective gear Apart from radiation protection, standard staff should wear a face shield or mask, impervious gowns, gloves, and shoe covers as appropriate.
Use the cannula to lift the roof of the papilla before attempting further insertion. Putting a curl on the tip of the cannula may facilitate cannulation. In addition, looping the cannula gently in the duodenum may help to align its tip with the axis of the CBD. Too much pressure on the cannula may impact the tip amongst the folds in the papilla and impede the ﬂow of contrast. Forceful injection of contrast may result in a submucosal injection. A metal tip cannula (bullet tip) is sometimes better than a standard Teﬂon cannula.
Advanced digestive endoscopy : ERCP by Peter B. Cotton