By Peter B. Cotton
Complex Digestive Endoscopy: ERCP addresses essentially the most advanced diagnostic and healing techniques for endoscopists. It presents the most recent considering and transparent guideline at the innovations, which were built-in with total sufferer care. Written through the prime foreign names in endoscopy, the textual content has been expertly edited by means of Peter Cotton right into a succinct, instructive structure. offered in brief paragraphs established with headings, subheadings and bullet issues and richly illustrated all through with full-color pictures
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Additional resources for Advanced digestive endoscopy : ERCP
Pushing the tip of the scope further into the duodenum may straighten the axis of the bile duct and increase the chance of directing the guidewire into the left hepatic duct. Selective cannulation can be performed using wires with a J or curved tip and a torque control to deﬂect the wire into the respective ductal system. Cannulation of the papilla in a Billroth II situation (Fig. 17) Previous gastrectomy or gastroenterostomy changes the anatomy of the stomach. The approach to the papilla is not through the usual route via the pylorus.
23 24 CHAPTER 3 Fig. 4 Organize accessories within easy reach for retrieval. Do not stack up, ‘ﬁle’ like books in a library with large clear/‘correct’ labels. Categorize in groups. Special accessories and tools. Fig. 5 Organization of worktop: water with simethicone for irrigation; 30% alcohol; 4 × 4 gauze; 20 ml syringe with blunt needle adaptor; 1 : 10 000 epinephrine; clips. Organization of the worktop (Fig. 5) To minimize cross-contamination of unopened accessories it is preferable to separate the clean and soiled items onto different worktops.
The length of the afferent loop may vary and affect the success of reaching the papilla. In situations where difﬁculty is encountered or the relevant segment is not clearly deﬁned, it is worth taking a biopsy close to the gastroenterostomy where the bleeding can serve to identify the jejunal segment that has been explored. If intubation with a side-viewing scope fails, it may be necessary to use a forwardviewing colonoscope to examine and intubate the afferent loop. If the papilla is successfully identiﬁed, it may be useful to place a Savary guidewire through the colonoscope and leave it in place to guide subsequent intubation with the sideviewing duodenoscope.
Advanced digestive endoscopy : ERCP by Peter B. Cotton