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ERCP Complicated Procedure

ERCP treatment in Sarjapur Road

Endoscopic retrograde cholangiopancreatography (ERCP) is a combined endoscopic and fluoroscopic protocol in which an endoscope is advanced into the duodenum's second part, allowing other tools to be passed into the biliary and pancreatic ducts via the major duodenal papilla. Contrast material can be injected into these ducts to allow for radiologic visualisation and, if necessary, therapeutic intervention. ERCP began as a diagnostic complicated procedure treatment in Sarjapur Road involving cannulation of the pancreatic and biliary ducts but has since evolved into a therapeutic tool. This activity discusses the indications and techniques for endoscopic retrograde cholangiopancreatography, as well as the role of the interprofessional team in the management of patients undergoing this procedure.

Objectives

  • Determine when endoscopic retrograde cholangiopancreatography is indicated.

  • Describe the procedure for performing endoscopic retrograde cholangiopancreatography.

  • Describe the risks of endoscopic retrograde cholangiopancreatography.

  • Explain interprofessional team strategies for improving care coordination and communication, as well as promote the appropriate and effective use of endoscopic retrograde cholangiopancreatography.

Procedure

Endoscopy is used in ERCP to locate the major and minor papillae. Cannulation is performed, and contrast material is injected to identify the biliary and pancreatic ductal systems. Diagnostic procedures, such as cholangiopancreatoscopy, biopsy, or brush cytology, can be performed during ERCP. An intraductal ultrasound may be performed as well. Sphincterotomy, stent placement, and stone removal are all therapeutic applications.

Obstructive jaundice, biliary or pancreatic ductal system disease treatment or tissue sampling, suspicion of pancreatic Cancer, pancreatitis of unknown cause, sphincter of Oddi manometry, nasobiliary drainage, biliary stenting for strictures and leakage, drainage of pancreatic pseudocysts, and balloon dilation of the duodenal papilla and ductal strictures are all indication Sphincterotomy is used to treat sphincter of Oddi dysfunction or stenosis, difficulties with biliary stenting or accessing the pancreatic duct, biliary strictures, bile duct stones, bile sump syndrome after choledochoduodenostomy, choledochocele, and poor surgical candidates with ampullary carcinoma.

Implementation

Endoscopic papillectomy, sphincter of Oddi manometry, sphincterotomy, endoscopic papillary balloon dilation, stone removal, tissue sampling, placement of biliary and pancreatic stents, cholangiopancreatoscopy, and biliary and pancreatic drainage are all techniques used in ERCP.

The procedure begins with the duodenoscope being passed through a mouthguard. The duodenoscope is then advanced into the duodenal bulb via the stomach pylorus. A protuberance at the junction of the horizontal and vertical duodenal folds is inserted to visualise the major duodenal papilla, and the scope should be advanced to the second part of the duodenum. The major duodenal papilla is then cannulated. The recommended wire-guided technique involves inserting a guidewire into the common bile duct or pancreatic duct before injecting contrast.

Technicalities

The dual operator system, also known as the mother-baby system, requires two endoscopists to operate, with one endoscopist controlling the mother duodenoscope and the other endoscopist controlling the baby cholangiopancreatoscope, with a tip that is only deflectable in one plane, up and down.

The SpyGlass technique is catheter-based, with the optical probe passing through a 4-lumen catheter with a deflectable tip up-down and right-left. The cholangioscope is passed through the 1.2 mm working channel of the therapeutic duodenoscope, over a guidewire, into the biliary duct in both the dual and single operator techniques. Consult with the best doctors to know more about treatment at Manipal Hospitals. 

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