Archive for the 'Endoscopic retrograde cholangiopancreatography' Category

04 Sep

Biliary access during endoscopic retrograde cholangiopancreatography: CONCLUSIONS

The biliary sphincter/intramural duct complex appears as a whitish mound if the incision is made to one side of the structure, or as circular muscle fibres if the cut has been made across it. Either the needle-knife catheter or a standard catheter or sphincterotome can be employed to cannulate the duct. Unless deep cannulation is […]

03 Sep

Biliary access during endoscopic retrograde cholangiopancreatography: Papillotomy (Part 2)

The direction of incision must be modified in certain circumstances; for example, the bile duct extends in the 7 o’clock direction (inverted papilla) in cases of Billroth II gastrojejunostomy or Roux-en-Y anastomosis. The segment of the bile duct that is ‘incised’ is the same intraduodenal or intramural segment that prevented success with standard approaches. It […]

02 Sep

Biliary access during endoscopic retrograde cholangiopancreatography: Papillotomy (Part 1)

Access papillotomy (entry cut, pre-cut) Access papillotomy should be considered when standard approaches to the bile duct or, less commonly, the pancreatic duct are unsuccessful and there is a clear indication (usually therapeutic) for cannulation. It should be undertaken by experienced endoscopists who achieve high success rates at conventional ERCP techniques and who perform many […]

01 Sep

Biliary access during endoscopic retrograde cholangiopancreatography: Ductography

Access without ductography It is important to shorten the intramural segment of the bile duct by lifting and angulating the papilla towards the 10 o’clock position for bile duct access (or towards the 3 o’clock position for pancreatic duct access) in order to facilitate entry of the wire into the desired duct. If this is […]

31 Aug

Biliary access during endoscopic retrograde cholangiopancreatography: APPLICATIONS

Guidewire diameter is measured in an antiquated fashion; some equivalents are listed in Table 3. However, the diameters of accessory instruments, are usually denoted by their outer diameters (not their inner diameters), and so their lumen sizes must be remembered, colour coded or read from the label. The endoscopist must be sure that guidewires fit […]

30 Aug

Biliary access during endoscopic retrograde cholangiopancreatography: GUIDEWIRES (Part 2)

The introduction of memory metals, such as nitinol (Nickel Titanium Naval Ordnance Laboratory) from military research, has spawned the development of strong, flexible guidewires that do not kink and exhibit little friction. Characteristics of specific wires are listed in Table 2. Surface coatings may be confined to the tip or the entire guidewire. Wires also […]

29 Aug

Biliary access during endoscopic retrograde cholangiopancreatography: GUIDEWIRES (Part 1)

Low surface friction enables advancement of the guidewire with less axial force but may decrease the ability to maintain tension without losing position. On the other hand, increased friction helps to maintain wire tension at the expense of impeding device movement. In addition, the presence of friction between the guidewire and the device makes it […]

28 Aug

Biliary access during endoscopic retrograde cholangiopancreatography (Part 2)

The endoscopist must develop skill in manipulating six two-directional vectors simultaneously, namely: •    advancement/withdrawal of the endoscope; •    right/left movements of the tip; •    up/down movements of the tip; •    right/left rotation of the control body; •    up/down control of the elevator; and

27 Aug

Biliary access during endoscopic retrograde cholangiopancreatography (Part 1)

Cannulation of the papilla during endoscopic retrograde cholangiopancreatography (ERCP) is often challenging to even skilled endoscopists. Many components of cannulation and access techniques are evanescent art forms that require careful application and meticulous application if they are to be mastered. Consequences of failed cannulation include increased morbidity and mortality, incomplete diagnosis and treatment, increased cost […]

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