New PDF release: Advanced digestive endoscopy : ERCP

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Extra resources for Advanced digestive endoscopy : ERCP

Sample text

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.

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