By Peter B. Cotton
Advanced Digestive Endoscopy: ERCP addresses probably the most complicated diagnostic and healing approaches for endoscopists. It offers the most recent considering and transparent guideline at the recommendations, that have been built-in with total sufferer care.
Written by way of the top foreign names in endoscopy, the textual content has been expertly edited by means of Peter Cotton right into a succinct, instructive layout. provided briefly paragraphs dependent with headings, subheadings and bullet issues and richly illustrated all through with full-color photos.
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Extra resources for Advanced Digestive Endoscopy: ERCP
Contrast studies Most diagnostic and therapeutic interventions are performed under ﬂuoroscopic control; however, radiographs or stored images should be taken for documentation. Hard copy radiographs give better resolution compared to the ﬂuoroscopic images and may reveal more detailed information. If common duct stones are suspected, early ﬁlling ﬁlms should be taken during injection of contrast. This may demonstrate a ‘meniscus’ sign where the stone is outlined by contrast within the duct. Excess contrast should be avoided as this tends to mask the small stones in a dilated duct.
An air-ﬁlled periampullary diverticulum may compress the FUNDAMENTALS OF ERCP Fig. 11 CholangiogramaCBD stones. 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.
Proper monitoring of blood pressure, pulse, and oxygenation helps to avoid this complication. The use of oxygen at 2 liters/min given via a nasal catheter helps to prevent hypoxia. Glucagon may increase the blood sugar level in diabetic patients and the anticholinergic effect of Buscopan may cause tachyarrhythmia. These unwanted side-effects should be monitored. Pancreatitis Pancreatitis is the commonest serious complication of ERCP. The serum amylase often increases transiently following pancreatography and may be of little clinical signiﬁcance.
Advanced Digestive Endoscopy: ERCP by Peter B. Cotton