By Peter B. Cotton
Advanced Digestive Endoscopy: ERCP addresses the most complicated diagnostic and healing strategies for endoscopists. It offers the most recent pondering and transparent guideline at the innovations, which were built-in with total sufferer care.
Written by means of the major 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 established with headings, subheadings and bullet issues and richly illustrated all through with full-color pictures.
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Rarely, parasites such as Clonorchis sinensis or Ascaris lumbricoides may be seen as unique ﬁlling defects in the extra- or intrahepatic bile ducts. 33 34 CHAPTER 3 Fig. 12 ERCP for gallbladder stones. Gallstones may be obvious on cholangiogram. Note aberrant duct which resembles cystic duct. Always check delayed ﬁlm of gallbladder for small stones. Gallbladder ERCP is not an ideal examination of the gallbladder. If the gallbladder is ﬁlled, a delayed ﬁlm of the gallbladder should be taken after 30– 45 min.
5) To minimize cross-contamination of unopened accessories it is preferable to separate the clean and soiled items onto different worktops. Long accessories tend to uncoil and they are best organized with a clip. FUNDAMENTALS OF ERCP A small pot of 30% alcohol is useful for cleaning the gloves (ﬁnger tips) to remove any sticky contrast or bile. Alcohol also reduces friction at the biopsy valve and facilitates insertion of accessories. Gauze pads are used for cleaning and wiping. Sterile water with simethicone can be ﬂushed down the channel to suppress bubbling in the duodenum to improve visualization.
Bending the tip of the cannula to form an angle facilitates cannulation. It is important to identify the correct location of the oriﬁce before any attempt is made to inject contrast, as trauma from the cannula may result in edema and bleeding and obscure the opening. If the papilla or oriﬁce is not obvious, it is useful to give secretin by slow IV infusion and wait 2 min to observe the ﬂow of pancreatic juice. During injection, it is important to monitor the contrast ﬁlling by ﬂuoroscopy as the tip of the cannula is often hidden by the endoscope in the long scope position.