By Peter B. Cotton
Complicated Digestive Endoscopy: ERCP addresses probably the most complicated diagnostic and healing approaches for endoscopists. It offers the newest considering and transparent guide at the strategies, that have been built-in with total sufferer care. Written through the prime foreign names in endoscopy, the textual content has been expertly edited through 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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Additional resources for Advanced digestive endoscopy : ERCP
16 Selective CBD cannulation. Stay close to papilla, approach from below, lift roof of papilla. Cannula directed at 11–12 o’clock position, use papillotome if needed. FUNDAMENTALS OF ERCP At the end of the procedure the endoscope is withdrawn and air is suctioned from the stomach to minimize discomfort. The patient is then turned to a supine position and more radiographs are taken in different projections (as previously described). In patients with a partially ﬁlled gallbladder, immediate diagnosis of gallstones may be difﬁcult due to inadequate mixing of contrast with bile.
Displacement or stretching of the side branches may suggest an underlying tumor in the pancreas. Congenital anomalies In patients with pancreas divisum, there is non-fusion of the dorsal and ventral ducts. The small isolated ventral pancreas drains through the main papilla. The dorsal (Santorini’s) duct drains the bulk of the pancreas through the minor papilla. FUNDAMENTALS OF ERCP Fig. 9 Cambridge Classiﬁcation of pancreatitis. Mild, three or more abnormal side branches. Moderate, abnormal main duct and side branches.
When ﬁlling the CBD, start with full strength contrast and consider switching over to dilute contrast when stones are visualized. If deep cannulation is successful, aspirate bile before injecting contrast to avoid excess contrast masking small stones in a dilated biliary system. The left hepatic ducts usually ﬁll before the right because they are dependent with the patient lying prone. The gallbladder is usually ﬁlled except in cases with cystic duct obstruction. Multiple spot ﬁlms are taken during contrast injection.
Advanced digestive endoscopy : ERCP by Peter B. Cotton