Endoscopic retrograde cholangiopancreatography (ercp) is an imaging diagnostic method for cholangiopancreatopathy and related lesions.
With the increasing maturity of this technology, and with the application of plastic stents, papillary sphincterotomy and lithotomy, lithotripsy, nasobiliary drainage, and metal stents and other related treatment techniques.
As a result, ercp has been developed from the original narrow diagnostic concept into a generalized ercp concept including the treatment of bile and pancreatic ducts and related diseases under duodenoscopy.
And with the continuous improvement of treatment technology and the development of other diagnostic methods, such as ct, mrcp, endoscopic ultrasonography (eus) and contrast-enhanced ultrasound, therapeutic ercp has become its main meaning, and the proportion of purely diagnostic ercp is higher. less and less.
When the guide wire protrudes from the catheter tip for a short time, the guide wire head is hard, which will also cause tissue damage. Do not use excessive force when the guide wire is inserted with resistance.
In the bile duct and pancreatic duct, the ERCP guidewire cannot be pulled back vigorously when there is resistance in pulling out, to avoid the macular guide wire head falling off, and the guide wire should be pulled back after the catheter is slightly retracted.
Push the brush out of the catheter along the guide wire over the stenosis section and then pull back the catheter. The cells are brushed to the stenosis section and then enter and exit the catheter. After brushing is completed, the cell brush is pulled back into the catheter and exit. , easy to cause bile duct damage, or even perforation.
To choose a stent with a suitable length (the length of the outer packaging mark of the stent is the length between the bilateral wings. The commonly used method for measuring the length of the stent placement is from the proximal end of the stenosis to the length of the duodenal papilla opening plus 1 to 2 cm for the required stent length. ).
The proximal flank of the plastic stent should exceed the proximal end of the stenosis to prevent the stent from shifting to the outside of the bile duct, falling off, or causing damage or even perforation on the duodenal wall at the tail end;
In the process of stent placement, pay attention to observing the images under the endoscope, avoid pushing the tail of the stent of ERCP products into the bile duct, and the assistant pays attention to observing the X-ray fluoroscopic images.
When the operator advances the stent, the inner cannula is pulled back synchronously, so as to prevent the inner cannula from pushing into the proximal end of the intrahepatic bile duct, making it difficult to place the stent or causing the stent to fail because the inner cannula is pulled out too quickly;
After the stent is placed, the inner cannula should be retracted first, and the guide wire should be withdrawn after observing the position and length of the stent.
enbd can effectively drain the bile duct, prevent and treat some complications after ercp diagnosis and treatment, the following problems should be paid attention to: the nasobiliary duct can cause esophageal varices to rupture and hemorrhage, and severe esophageal varices are prohibited from enbd;
The nasobiliary duct falls off, and the nasobiliary duct follows the gastrointestinal path when the mirror is withdrawn, especially to avoid the duodenal catheter being too long, and it should be wrapped around the ear during external fixation to prevent the catheter from being pulled out directly;
When the pigtail nasobiliary duct is placed, the pressure of the external traction catheter can easily lead to ulcers in the upper corner of the duodenum; improper fixation of the nasobiliary duct outside the nose can cause nasal mucosal ulcers;
When the enbd tube is broken in the pharynx, the drainage is not smooth. After the catheter is drawn out of the nasal cavity, the bile can be smoothly extracted from the ERCP products catheter or the contrast agent can be injected smoothly (note that a small amount of contrast agent is injected when the bile duct is not needed to be visualized again).
In short, before the diagnosis and treatment of ercp, the patient should be prepared before the operation, and the general condition of the patient should be fully understood.
Carefully operate every step during the operation, strictly abide by the operation specifications, prevent the occurrence of complications, and timely detect and correctly handle the complications, so as to minimize the complications after ercp.
And the complications that appear can be treated in a timely and effective manner to avoid serious consequences, so that the vast number of patients with pancreatic diseases can benefit more from ercp diagnosis and treatment.