By Peter B. Cotton
Advanced Digestive Endoscopy: ERCP addresses the most complicated diagnostic and healing approaches for endoscopists. It presents the newest considering and transparent guideline at the thoughts, that have been built-in with total sufferer care.
Written through the top foreign names in endoscopy, the textual content has been expertly edited by means of Peter Cotton right into a succinct, instructive structure. awarded in brief paragraphs based with headings, subheadings and bullet issues and richly illustrated all through with full-color photos.
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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. This allows time for the contrast to mix with bile for better deﬁnition of gallstones (Fig. 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.
It is useful to insert the cannula and be ready for cannulation before performing ﬁne adjustment of the scope position. Locking the wheel that controls sideways angulations helps to minimize movement. Cannulation is best performed with the papilla positioned in the center of the endoscopy ﬁeld. Proper alignment is achieved by a combination of up/down and 45 46 CHAPTER 3 left/right angulations, rotation of the tip of the scope, and pulling back or pushing the tip of the scope further into the duodenum.
A stiffer instrument such as a sphincterotome can be used to dislodge the impacted stone. g. impacted stone or tumor). Since precutting carries signiﬁcant hazards, and other safer techniques are available, it should be used only with great caution. There should be a speciﬁc indication and a strong need to gain access into the bile duct, such as palliation of malignant jaundice. Precut sphincterotomy should not be performed for a diagnostic ERCP or as an alternative to a good biliary cannulation technique.