By Peter B. Cotton
Advanced Digestive Endoscopy: ERCP addresses essentially the most complicated diagnostic and healing systems for endoscopists. It presents the most recent considering and transparent guide at the innovations, that have been built-in with total sufferer care.
Written through the major overseas names in endoscopy, the textual content has been expertly edited through Peter Cotton right into a succinct, instructive structure. offered in brief paragraphs based with headings, subheadings and bullet issues and richly illustrated all through with full-color photos.
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The patient should now be placed to lie in a prone position. The papilla is normally seen when the scope is returned to the neutral position after this shortening maneuver, with the markings of 65–70 cm at the incisor level in the majority of patients. If examination of the stomach is performed with the patient in a prone position, initial rotation of the scope to the left will compensate for a change in the axis and make the examination easier. Failure to identify the papilla Tip of endoscope is too proximal The tip of the scope falls short of the second part of the duodenum.
Passage of the scope down the small intestine is similar to doing a colonoscopy with a side-viewing endoscope. The presence of bile in the lumen does not always predict the afferent loop. It is helpful to monitor the passage of the endoscope on ﬂuoroscopy to determine the direction and position of the scope. It is unlikely that the scope is in the afferent loop if the tip is down in the pelvis on ﬂuoroscopy. The length of the afferent loop may vary and affect the success of reaching the papilla.
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. Long accessories tend to uncoil and they are best organized with a clip. FUNDAMENTALS OF ERCP A small pot of 30% alcohol is useful for cleaning the gloves (ﬁnger tips) to remove any sticky contrast or bile.