Advanced digestive endoscopy : ERCP by Peter B. Cotton

By Peter B. Cotton

Complicated Digestive Endoscopy: ERCP addresses essentially the most complicated diagnostic and healing approaches for endoscopists. It presents the most recent considering and transparent guideline at the suggestions, that have been built-in with total sufferer care. Written through the major overseas names in endoscopy, the textual content has been expertly edited via Peter Cotton right into a succinct, instructive layout. awarded briefly paragraphs based with headings, subheadings and bullet issues and richly illustrated all through with full-color images

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To reduce the weight of the lead apron on the shoulder, a skirt and a vest can be used. A lead collar should be worn to protect the thyroid gland, and lead glasses are recommended, especially if a fluoroscopy unit with an over-couch tube is 27 28 CHAPTER 3 used. Individuals should also wear their X-ray badge on the outside for monitoring purposes. It is necessary to use external lead shielding of the reproductive organs for young or female patients. Other protective gear Apart from radiation protection, standard staff should wear a face shield or mask, impervious gowns, gloves, and shoe covers as appropriate.

Type III strictures involve the right and left hepatic ducts. • Type IIIa is involvement of the right side and IIIb is involvement of the left side. • Type IV is multiple intrahepatic segmental involvement. Malignant bile duct strictures can sometimes be difficult to distinguish from primary sclerosing cholangitis, which classically shows multiple strictures and diffuse irregularity of the extra- and intrahepatic biliary system. In contrast, benign postsurgical strictures usually appear as smooth shortsegment stenoses.

Isosmolar non-ionic contrast agents are more expensive but should be used in patients allergic to iodine. In addition, it is advisable to give these patients steroid prophylaxis and benadryl prior to the procedure to prevent contrast reaction. Contrast should be drawn up in clearly labeled syringes prior to the procedure and be ready for use. It is preferable to have at least two 20 ml syringes filled with contrast of normal and half normal strength. A 20 ml syringe is used for contrast injection because it is easy to handle, contains sufficient volume of contrast, and permits injection by the endoscopist.

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