Pancreatitis is the most common complication of ERCP. The incidence of pancreatitis is 1.3% in one-time pancreatic duct imaging, 9.7% in 5-7 times, and 19.5% in more than 10 times. The occurrence of pancreatitis is related to the following factors: multiple intubation and multiple imaging of the pancreatic duct, repeated imaging of the pancreatic duct leads to excessive pressure in the pancreatic duct, excessive contrast agent damages the pancreatic duct and acinar epithelial cells; mechanical damage to the opening of the pancreatic duct; Accidental or excessive burns of the pancreatic duct opening and surrounding mucosa during preparatory incision and EST.
Use ERCP guidewire to exchange various instruments to make the operation more accurate and safer. It can reduce the number of re-intubation by repeatedly searching for the target bile duct or pancreatic duct. For example, if a smart knife with a guide wire is directly applied during angiography, it can be determined whether to make an incision according to needs after angiography. If an incision is required and the guide wire is inserted into the bile duct, the incision knife will not easily slip out of the bile duct; if treatment is required after the incision, it can be Insert the guide wire deeply into the bile duct or pancreatic duct again, exit the incision knife, and replace it with the corresponding instrument.
The X-ray opaque nature of the guide wire can reduce the application of contrast agents. Judging the direction of the pancreaticobiliary duct according to the direction of the guide wire, which can significantly reduce the intraductal high pressure caused by the overfilling of the pancreatic duct by the contrast agent and the toxic effect of the contrast agent, which damages the epithelium and acinus of the duct wall. At the same time, the tip of the macular guide wire is extremely soft. It is hydrophilic and has little damage to the pancreatic duct wall, so that the incidence of postoperative pancreatitis and hyperamylase can be reduced.
Cholangitis is another important complication after ERCP surgery, and its occurrence is usually due to equipment contamination, excessive injection of contrast agent into the bile duct, bile duct stenosis, or unremoved bile duct stones or lithotripsy resulting in poor bile drainage, and the drainage range is less than 40% of the whole liver and so on, so the bacteria will reside and multiply causing the infection. Once it occurs, effective drainage measures should be taken while actively fighting infection.
During angiography, the ERCP guidewire enters the middle of the bile duct and injects the contrast agent. If the stone is small, place the guide wire on the stone under fluoroscopy, and then inject the drug along the guide wire into the catheter to avoid pushing the stone into the intrahepatic bile duct. After opening, enter the stone extraction instrument along the guide wire to avoid missing small stones. For deep intubation, especially when a stent needs to be placed in the hilar tumor, the advantages of smooth and soft front end of the guide wire are used to enter by light twisting, heavy twisting, proper advancement, shaking, etc. Angiography tube and other instruments are used to change the running direction of the guide wire and enter the target bile duct. When used in conjunction with other devices, attention should be paid to adjusting the distance between the guide wire and the catheter, the tension of the incisor wire, and the different insertion depths of the balloon, so that the guide wire can directly enter the target bile duct, or an additional guide wire can be inserted to make it rebound. Folded into a loop and hooked into the target bile duct, the straight guide wire is easy to enter the right intrahepatic bile duct, and the elbow guide wire combined with other instruments is easy to enter the left intrahepatic bile duct. The guide wire entering the target bile duct is the key to smooth operation and achieve the expected diagnosis and treatment effect. , When the tumor in the hilar requires the placement of double stents or multiple stents, it can be done with double guide wires. The guide wire technique can be used to drain as many sites as possible to expand the drainage range. At the same time, the guide wire is not transparent to X-rays. properties that can reduce the application of contrast agents. The occurrence of cholangitis is minimized.
The incidence of stone and stone extraction basket impaction is low, mainly occurs when the lower end of the bile duct is narrow, the stone is large and hard, and the stone is trapped with the basket and then incarcerated at the lower end of the bile duct, which cannot be loosened and withdrawn from the basket. The use of extracorporeal lithotripsy was switched, but there were also failures. In the routine group, 1 case of stone was too hard, and the extracorporeal lithotripsy could not crush the stone, so emergency surgery was performed to remove the basket and the stone. At present, our method is to enter the balloon along the guide wire, inflate the balloon to the size of the stone to be removed, and then pull down the balloon. If the stone is pulled out of the nipple smoothly, the stone can be removed. If it is difficult, put the guide wire in advance. Into the bile duct, and then insert the mesh basket to try to extract the stone, which can reduce the occurrence of stone impaction. Even if the stone cannot be removed, the nasobiliary duct can be placed along the guide wire for external drainage.
ERCP and its related technologies have been widely carried out in major hospitals and have become one of the main methods for the treatment of pancreatic and gallbladder diseases, enabling countless patients with hepatobiliary and pancreatic diseases to receive clear diagnosis and effective treatment. We should continue to explore, summarize and improve the operation skills of ERCP guidewire, flexibly apply the guide wire, improve the operation technique, and reduce the incidence of complications.