By Peter B. Cotton
The newest variation of the world-leading identify useful Gastrointestinal Endoscopy (published in may possibly 2003) has a 'back to fundamentals' procedure - putting emphasis on perfecting the fundamental options of endoscopy. there's now a necessity for unique useful and medical courses to the complicated endoscopy ideas for more matured physicians.
Advanced Digestive Endoscopy: ERCP addresses essentially the most advanced diagnostic and healing tactics for endoscopists. It presents the most recent considering and transparent guide at the strategies, that have been built-in with total sufferer care.
Written through the best foreign names in endoscopy, the textual content has been expertly edited through Peter Cotton right into a succinct, instructive structure. offered in brief paragraphs dependent with headings, subheadings and bullet issues and richly illustrated all through with full-color images.
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Extra info for Advanced Digestive Endoscopy - ERCP
29 30 CHAPTER 3 The pancreatic duct normally has a smooth, slightly wavy course from the papilla tapering towards the tail. In the head a branch duct is seen draining the uncinate process. In addition, the accessory duct (Santorini’s duct) drains through the minor papilla. In 5% of cases a prominent branch duct runs parallel to the main pancreatic duct giving the appearance of a biﬁd pancreas. Several branch ducts join the main pancreatic duct at irregular intervals, usually at right angles to the main duct.
It may be prominent in cases with obstruction of the main pancreatic oriﬁce or with underlying pancreatitis. Cannulation of the minor papilla is necessary in patients with suspected pancreas divisum to outline the dorsal pancreatic duct. Cannulation is best performed in a long scope position and with the scope tip angled slightly to the right. This maneuver will put the accessory papilla in the center of the endoscopy ﬁeld. In most cases, the minor papilla is not obvious and cannulation is difﬁcult.
FUNDAMENTALS OF ERCP A small pot of 30% alcohol is useful for cleaning the gloves (ﬁnger tips) to remove any sticky contrast or bile. Alcohol also reduces friction at the biopsy valve and facilitates insertion of accessories. Gauze pads are used for cleaning and wiping. Sterile water with simethicone can be ﬂushed down the channel to suppress bubbling in the duodenum to improve visualization. Fluoroscopy for ERCP ERCP is ideally performed with the help of a radiologist, but more commonly with the help of a trained radiology technician.
Advanced Digestive Endoscopy - ERCP by Peter B. Cotton