Position for cholangiopancreatography

Pancreaticocholangiopancreatography is also a relatively common examination method. It mainly involves inserting an endoscope into the descending segment of the duodenum, injecting contrast agent, and performing X-ray of the pancreaticobiliary duct. This has a good examination effect for acute biliary pancreatitis or biliary tumors, and has become a relatively important treatment method for biliary and pancreatic diseases. It has important diagnostic significance for unexplained obstructive jaundice, or various biliary stones and tumors.

Introduction to endobiliary cholangiopancreatography (ERCP) In addition, treatments such as sphincterotomy, bile and pancreatic duct lithotripsy, bile and pancreatic duct stent placement and drainage, nasobiliary drainage and biliary ascariasis removal can be performed. It is mainly used to treat diseases such as stones at the lower end of the common bile duct, pancreatic duct stones, biliary tumors, acute biliary pancreatitis and biliary ascariasis. Compared with traditional surgical operations, it has the advantages of less trauma, faster recovery and lower cost, and has become an important means of treating biliary and pancreatic diseases.

1. Indications 1. Obstructive jaundice of unknown cause suspected of extrahepatic biliary obstruction. 2. Patients suspected of having various biliary diseases such as stones, tumors, sclerosing cholangitis, etc. with unknown diagnosis. 3. Patients suspected of having congenital bile duct abnormalities or recurrence of symptoms after cholecystectomy. 4. Pancreatic diseases: pancreatic tumors, chronic pancreatitis, pancreatic cysts, etc. II. Contraindications 1. Patients with severe cardiopulmonary or renal insufficiency. 2. Acute pancreatitis or acute exacerbation of chronic pancreatitis. 3. Severe biliary infection 4. Allergy to iodine contrast medium III. Preoperative preparation 1. Same as gastroscopy. Perform iodine contrast agent allergy test. 2. Instrument preparation: Duodenoscope, ERCP abnormality (75% alcohol soaking and disinfection for 30'~60'). Sterilize syringes, etc. 3. Preoperative medication: 50 mg of pethidine intramuscularly and 20 mg of buscopan intravenously. 4. Operation points

1. Insert the endoscope: According to the method of gastroscopy, insert the endoscope quickly through the gastric cavity, pylorus, and into the descending duodenum. During this process, try to keep air injection as little as possible. 2. Locate the nipple: Rotate the patient's body position, with prone position being the most commonly used. Straighten the mirror body and adjust the angle knob so that the nipple is in the upper left of the field of vision. Identifying and aligning with the nipple opening is the key to successful intubation. 3. Insert the catheter: insert the catheter through the biopsy hole, adjust the angle button and the lifting forceps to make the catheter perpendicular to the nipple opening, insert the catheter into 1-2 marks and inject contrast agent, which can usually display the pancreatic duct and bile duct at the same time, called ERCP. Currently, selective pancreatic duct (ERP) or bile duct (ERC) angiography is advocated. 4. Contrast imaging: Inject 2-3 ml of 30% cholangiocarbamide under fluoroscopy. When the pancreatic duct or bile duct is visualized on the fluorescent screen, continue to slowly inject the contrast agent until the desired duct is visualized. About 4-5 ml is required for visualization of the main pancreatic duct. For selective pancreatic duct visualization, the dosage of contrast agent and the injection pressure should be properly controlled and not too much. Only 10 to 20 ml is needed to fill the bile duct, and 40 to 60 ml is needed to fully display the gallbladder.

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