Endoscopic retrograde cholangiopancreatography

Use of endoscopy and fluoroscopy to treat and diagnose digestive issues .
“ ERCP ” redirects here. For embedded Rich Client Platform, see IBM Lotus Expeditor
Endoscopic retrograde cholangiopancreatography ( ERCP ) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. It is chiefly performed by highly skilled and forte train gastroenterologists. Through the endoscope, the doctor can see the inside of the digest and duodenum, and inject a contrast medium into the ducts in the bilious corner and pancreas so they can be seen on radiogram. ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, [ 1 ] including gallstones, inflammatory strictures ( scars ), leaks ( from trauma and surgery ), and cancer. ERCP can be performed for diagnostic and curative reasons, although the development of safe and relatively non-invasive investigations such as charismatic resonance cholangiopancreatography ( MRCP ) and endoscopic sonography has meant that ERCP is now rarely performed without therapeutic intent.

aesculapian uses [edit ]

diagnostic [edit ]

The following constitute indications for ERCP, peculiarly if or when less encroaching options are not adequate or definitive :
Fluoroscopic image of park bile duct stone seen at the time of ERCP. The stone is impacted in the distal park bile duct. A nasobiliary tube has been inserted . Fluoroscopic picture showing dilatation of the pancreatic duct during ERCP investigation. Endoscope is visible .

therapeutic [edit ]

ERCP may be indicated in the above diagnostic scenarios when any of the following are needed :

Contraindications [edit ]

  • Hypersensitivity to iodinated contrast medium
  • History of iodinated contrast dye anaphylaxis (although iodine-free contrast is now available)
  • Acute pancreatitis (unless persistently elevated or rising bilirubin suggests ongoing obstruction)
  • (Irreversible) coagulation disorder if sphincterotomy planned
  • Recent myocardial infarction or pulmonary embolism
  • Severe cardiopulmonary disease or other serious morbidity

routine [edit ]

Diagram of an endoscopic retrograde cholangio pancreatography ( ERCP ) The patient is sedated or anaesthetized. then a flexible television camera ( endoscope ) is inserted through the sass, down the esophagus, into the stomach, through the pylorus into the duodenum where the ampulla of Vater ( the marriage of the park bile duct and pancreatic duct ) exists. The sphincter of Oddi is a brawny valve that controls the afford to the ampulla. The region can be directly visualized with the endoscopic television camera while diverse procedures are performed. A fictile catheter or cannula is inserted through the ampulla, and radiocontrast is injected into the bile ducts and/or pancreatic duct. Fluoroscopy is used to look for blockages, or other lesions such as stones. [ citation needed ] When needed, the sphincters of the ampulla and bile ducts can be enlarged by a cut ( sphincterotomy ) with an electrify wire called a sphincterotome for access into either so that gallstones may be removed or other therapy performed. [ citation needed ]

other procedures associated with ERCP include the trawl of the coarse bile duct with a basket or balloon to remove gallstones and the insertion of a credit card stent to assist the drain of bile. besides, the pancreatic duct can be cannulated and stents be inserted. The pancreatic duct requires visual image in cases of pancreatitis. [ citation needed ] In specific cases, early specialized or accessory endoscopes may be used for ERCP. These include mother-daughter and SpyGlass cholangioscopes ( to help in diagnosis by directly visualizing the duct as opposed to entirely obtaining roentgenogram images [ 4 ] ) american samoa well as balloon enteroscopes ( e.g. in patients with post- Whipple or Roux-en-Y surgical anatomy ). [ 5 ]

Risks [edit ]

One of the most frequent and fear complications after endoscopic retral cholangiopancreatography ( ERCP ) is post-ERCP pancreatitis ( PEP ). In previous studies, the incidence of PEP has been estimated at 3.5 to 5 %. [ 6 ] [ 7 ] According to Cotton et al., PEP is defined as a “ clinical pancreatitis with amylase at least three times the upper berth restrict of convention at more than 24 hours after the routine requiring hospital entree or prolongation of design admission ”. Grading of badness of PEP is chiefly based on the length of hospital stay. [ 8 ] risk factors for developing PEP include technical foul matters related to the ERCP procedure and patient-specific ones. The technical factors include handling of and injection of contrast into the pancreatic duct, cannulation attempts lasting more than five minutes, and bilious balloon sphincter dilation ; among patient-related factors are female sex, younger old age, and Sphincter of Oddi dysfunction. [ 9 ] [ 10 ] A systematic review of clinical trials concluded that a former history of PEP or pancreatitis significantly increases the risk for PEP to 17.8 % and to 5.5 % respectively. [ 11 ] intestinal perforation is a risk of any gastroenterologic endoscopic procedure, and is an extra risk if a sphincterotomy is performed. As the second base separate of the duodenum is anatomically in a retroperitoneal placement ( that is, behind the peritoneal structures of the abdomen ), perforations due to sphincterotomies are retroperitoneal. Sphincterotomy is besides associated with a risk of bleeding. [ 12 ] There is besides a risk associated with the contrast dye in patients who are allergic to compounds containing tincture of iodine. [ citation needed ] Oversedation can result in perilously first gear rake blackmail, respiratory depression, nausea, and vomiting. [ citation needed ] early complications ( less than 1 % ) may include heart and lung problems, contagion in the bile duct called cholangitis. Using antibiotics before the routine shows some benefits to prevent cholangitis and blood poisoning. [ 13 ] In rare cases, ERCP can cause fateful complications. [ 14 ]

Cases of hospital-acquired ( i.e., nosocomial ) infections with carbapenem resistant enterobacteriaceae linked to incompletely disinfect duodenoscopes have occurred in the U.S. since at least 2009 per the Food and Drug Administration. [ 15 ] Outbreaks were reported from Virginia Mason Hospital in Seattle in 2013, UCLA Health System Los Angeles in 2015, Chicago and Pittsburgh. [ 16 ] The FDA issued a base hit communication “ Design of ERCP Duodenoscopes May Impede Effective Cleaning ” in February 2015, [ 17 ] which was updated in December 2015. [ 18 ]

See besides [edit ]

References [edit ]

beginning : https://www.bestofcalgary.city
Category : Health

Leave a Reply

Your email address will not be published.