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With the ever-changing performance of endoscopes and their accessories, the skilled medical staff, and the increasing demands for medical care from patients.
Retrograde cholangiopancreatography through the duodenal papilla is an important minimally invasive method for the diagnosis and treatment of cholangiopancreatic duct diseases. Guide wire is one of the commonly used instruments in ERCP and plays a pivotal role.
1. Shaking method: Slowly shake the guide wire as you advance and retreat, and advance while shaking. The intensity and amplitude of shaking and advancing should be just right. With the feeling of resistance on the operator's hand, make the tip of the guide wire enter the narrow part along the opening.
2. Twisting method: Because the stenosis is too severe or the stenosis section is too long, the ERCP guidewire cannot be inserted by the shaking method, and the guide wire can be inserted in the clockwise direction by twisting the guide wire.
The push method and the twisting method should be organically coordinated, and excessive force should not be used. When inserting the ERCP guidewire, an arcuate incision knife is generally used for intubation, which can avoid re-intubation during nipple incision.
After successful intubation, fluoroscopy is performed to understand that the guide wire is in the pancreatic duct or bile duct, and a contrast agent can be selectively injected to prevent the injection of too much contrast agent into the pancreatic duct and avoid the occurrence of pancreatitis.
If the catheter only enters the pancreatic duct but not the bile duct during intubation, the ERCP guidewire can be placed in the pancreatic duct to fix the direction of the nipple and facilitate the insertion of the catheter into the bile duct.
If the stone is small, the guide wire can be placed on the stone under fluoroscopy, and then the contrast medium can be injected along the guide wire into the contrast tube. The contrast medium should not be injected too fast to prevent the stone from entering the intrahepatic bile duct.
When the guidewire passes over the stenosis, the dilator is inserted to dilate the stenotic bile duct, thereby draining the bile.
First, find the entrance of the bile duct under the X-ray, adjust the distance between the guide wire and the catheter such as the balloon or the scalpel, until the tip of the guide wire is just exposed and the catheter can be guided. After the guide wire is aligned with the entrance of the bile duct, the catheter should be shaken or twisted. method to insert the guide wire.
Inserting the guide wire into the bile duct can fix the direction of the nipple, avoid miscutting the pancreatic duct and repeatedly inserting the pancreatic duct; shorten the operation time and avoid the occurrence of pancreatitis, and the direction and length of the incision are easy to grasp, highlighting the routine use Advantages of trocar intubation.
The guide wire can be used to pass the stone to remove the stone, and the stone extraction balloon or the stone extraction basket can be inserted along the guide wire to remove the stone.
Putting the guide wire into the bile duct to remove stones can reduce the chance of stone incarceration for beginner medical personnel when removing stones, and it is also convenient for stone removal instruments to be inserted back and forth into the bile duct, saving intubation time, and using the guide wire to guide the placement of the nasobiliary drainage tube becomes more effective with less effort.
First, pass the guide wire over the stenotic section (the bile duct that is too narrow should be expanded with a probe or dilation balloon), and then take out the dilator and indwelling the guide wire for stent placement. If multiple ercp stents need to be placed, another guide wire should be inserted into the bile duct.