By Peter B. Cotton
Complex Digestive Endoscopy: ERCP addresses probably the most advanced diagnostic and healing tactics for endoscopists. It presents the most recent considering and transparent guideline at the innovations, that have been built-in with total sufferer care. Written via the top overseas names in endoscopy, the textual content has been expertly edited via Peter Cotton right into a succinct, instructive layout. awarded in brief paragraphs established with headings, subheadings and bullet issues and richly illustrated all through with full-color images
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Extra resources for Advanced digestive endoscopy : ERCP
It is necessary to take hard copy spot ﬁlms to document any therapeutic interventions. Alternatively, serial digital images are stored and retrieved at the end of the procedure for reporting and ﬁling. The pancreatogram Normal anatomy The pancreas is a retroperitoneal organ lying across the abdomen at the level of L1 and L2. Pancreatic calciﬁcations on the control ﬁlm suggest chronic pancreatitis and rarely pancreatic neoplasm. A good quality pancreatogram should demonstrate the main pancreatic duct up to the tail with adequate ﬁlling of the second generation branch ducts.
The posterior segments of the right hepatic system are non-dependent in the prone position but may be ﬁlled more readily by turning the patient to a supine position. g. papillary dysfunction or stenosis. Drainage ﬁlms may be taken with the patient in the right lateral position or in the Trendelenburg position. The normal rate of drainage is affected by many factors and precise normal limits have not been established. Delayed drainage is, however, suspected if signiﬁcant opaciﬁcation of the bile duct persists after 45 min, and after 10 min for the pancreatic duct.
Needle-knife precut technique Precutting with the needle-knife is performed in two ways, either by inserting the knife into the papilla and gently moving upwards, or by incising downwards from above the papilla. Prior insertion of a stent into the pancreatic duct protects the pancreatic oriﬁce and may minimize the risk of pancreatitis. Precut needle-knife sphincterotomy over a stent is also used to perform accessory sphincterotomy for pancreas divisum. Selective cannulation of the intrahepatic system (IHBD) In a standard short scope position, the angulation of the scope, curvature of the cannula, and shape of the CBD all favor cannulation of the right hepatic system.
Advanced digestive endoscopy : ERCP by Peter B. Cotton