By Peter B. Cotton
The newest variation of the world-leading name useful Gastrointestinal Endoscopy (published in might 2003) has a 'back to fundamentals' process - putting emphasis on perfecting the fundamental ideas of endoscopy. there's now a necessity for precise useful and scientific courses to the complex endoscopy innovations for more matured physicians.
Advanced Digestive Endoscopy: ERCP addresses essentially the most advanced diagnostic and healing tactics for endoscopists. It offers the newest pondering and transparent guide at the recommendations, which were built-in with total sufferer care.
Written by way of the top overseas names in endoscopy, the textual content has been expertly edited by way of Peter Cotton right into a succinct, instructive structure. awarded briefly paragraphs dependent with headings, subheadings and bullet issues and richly illustrated all through with full-color photos.
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Extra info for Advanced Digestive Endoscopy - ERCP
In addition, looping the cannula gently in the duodenum may help to align its tip with the axis of the CBD. Too much pressure on the cannula may impact the tip amongst the folds in the papilla and impede the ﬂow of contrast. Forceful injection of contrast may result in a submucosal injection. A metal tip cannula (bullet tip) is sometimes better than a standard Teﬂon cannula. The smooth radiopaque metal tip facilitates cannulation under ﬂuoroscopy. Injection of a small amount of contrast during attempted cannulation to outline either ductal system will help in correct orientation or alignment.
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. In situations where difﬁculty is encountered or the relevant segment is not clearly deﬁned, it is worth taking a biopsy close to the gastroenterostomy where the bleeding can serve to identify the jejunal segment that has been explored.
Digital units can store the images onto a computer for subsequent retrieval and review. Hard copies of selected images can be printed for reporting and ﬁling. It is essential to know the magniﬁcation Fig. 6 Fluoroscopy machine with under-couch tube. Digital C-arm for designated ERCP room. Full ﬂuoroscopy unit if shared facilities in Radiology. Remote control and foot pedal. Image capture. 25 26 CHAPTER 3 factor of the machine for correct interpretation of X-ray ﬁndings, and for measuring the size of stones and the length of strictures.
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