By Peter B. Cotton
Advanced Digestive Endoscopy: ERCP addresses essentially the most complicated diagnostic and healing techniques for endoscopists. It offers the newest pondering and transparent guideline at the ideas, that have been built-in with total sufferer care.
Written by means of the prime overseas names in endoscopy, the textual content has been expertly edited by way of Peter Cotton right into a succinct, instructive layout. offered in brief paragraphs based 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
Care must be taken to avoid giving excess oxygen which may lead to respiratory depression in patients with COPD. Measuring the end-expiration CO2 level using capnography is carried out in some centers. Contrast agents The most commonly used contrast media such as conray 280, urograﬁn, hypaque, and renograﬁn contain iodine. Contrast media used for ERCP include both hyperosmolar ionic medium and isosmolar, non-ionic medium. Isosmolar non-ionic contrast agents are more expensive but should be used in patients allergic to iodine.
In the long scope position, the tip of the cannula may be hidden behind the endoscope on ﬂuoroscopy but contrast is seen ﬂowing across the spine when the dorsal duct is ﬁlled. 018 inch ﬂexible tip guidewire contained in a ﬁne tip Teﬂon cannula, using the tip of the guidewire to explore the oriﬁce. Once the guidewire is inserted into the dorsal pancreatic duct, the cannula is advanced over the guidewire and contrast is injected through the cannula after removal of the guidewire. It is worth remembering that cannulation of the main pancreatic duct via the main papilla may fail even in patients without pancreas divisum.
13) The cannula or diagnostic catheter is a 6 or 7 Fr Teﬂon tube which tapers to a 3–5 Fr tip. It is used for injection of contrast into the ductal systems. A variety of cannulas are available with different tip designs. A commonly used example is the bullet tip or ﬂuorotip catheter, which has a small metal or radiopaque tip at 35 36 CHAPTER 3 Fig. 13 Accessories: cannula, guidewire, and papillotome. the end to facilitate orientation and cannulation on ﬂuoroscopy. Other catheters may have a tapered tip which facilitates cannulation.