By Peter B. Cotton
Advanced Digestive Endoscopy: ERCP addresses the most complicated diagnostic and healing methods for endoscopists. It presents the most recent considering and transparent guideline at the concepts, that have been built-in with total sufferer care.
Written by means of the best overseas names in endoscopy, the textual content has been expertly edited through Peter Cotton right into a succinct, instructive structure. 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
If no obvious ﬂow of pancreatic juice is observed at the minor papilla after injection of secretin, it is wise to re-examine the main papilla. A good ﬂow of pancreatic juice at the main papilla suggests that the patient does not have pancreas divisum and further cannulation attempts should be made at the main papilla. Failure to obtain deep CBD cannulation This usually results from a failure to align with the correct axis of the bile duct. Pushing the tip of the cannula may distort the papilla.
Sometimes sideways angulation is necessary to achieve a correct alignment with the axis of the bile duct. Frequent injection of small amounts of contrast during manipulation helps to guide the sphincterotome. FUNDAMENTALS OF ERCP When conventional methods of deep cannulation fail, a guidewire can be used to cannulate the bile duct. It is helpful to have contrast present in the pancreatic duct to guide the direction of the guidewire. g. Metro tracer wire from Wilson Cook). The ﬂexible tip guidewire is inserted through a catheter or a sphincterotome and 5 mm of the tip is pushed gently in the direction of the CBD.
Pancreatic stones may obstruct the pancreatic duct and prevent proper ﬁlling. Pancreatic cannulation may be facilitated by using a ﬂexible tip guidewire. 47 48 CHAPTER 3 Pancreatic duct cannulation may fail in cases with pancreas divisum since there may be no ventral duct. Failed accessory (minor) papilla cannulation Identiﬁcation of the accessory or minor papilla can sometimes be difﬁcult. The minor papilla is located in the second part of the duodenum, to the right and proximal to the main papilla.