By Peter B. Cotton
Advanced Digestive Endoscopy: ERCP addresses one of the most complicated diagnostic and healing techniques for endoscopists. It presents the newest considering and transparent guideline at the concepts, that have been built-in with total sufferer care.
Written by means of the best foreign names in endoscopy, the textual content has been expertly edited by way of Peter Cotton right into a succinct, instructive structure. offered in brief paragraphs dependent with headings, subheadings and bullet issues and richly illustrated all through with full-color pictures.
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Extra resources for Advanced Digestive Endoscopy: ERCP
Failed pancreatic duct cannulation The most common cause is an improper axis. The pancreatic duct is best entered by directing the cannula perpendicular to the duodenal wall in the 1 o’clock position. It is sometimes necessary to withdraw the tip of the scope, relaxing the upward angulation together with adjustment of the sideways angulation and lowering the elevator to drop the cannula. Taking a radiograph in cases with an apparent failed cannulation may sometimes reveal a small ventral pancreas.
At the end of the procedure, additional radiographs may be taken with the patient in a supine position. A change of position allows gravity to ﬁll the more dependent portion of the right intrahepatic system and also the tail of the pancreas. Positioning the patient in the right oblique position moves CBD off the spine and may reveal the cystic duct which sometimes overlaps with the CBD. This position may also allow a better examination of the gallbladder. In rare circumstances, ERCP may be performed with the patient in a supine position.
Common duct stones seen in different size, shape, and number. Stones can form around a migrated surgical clip. distal common duct giving rise to a pseudostricture formation. In these cases, the distal bile duct is seen to ‘open up’ when air is removed from the diverticulum. Bile duct stones (Fig. 11) Stones within the bile duct may be demonstrated initially as a meniscus sign upon contrast injection and subsequently as ﬁlling defects. They are round or faceted depending upon their origin. It may be necessary to change the scope position into a long scope position to expose the mid/distal CBD, an area otherwise overlapped by the scope.