Intubation is the first threshold of many difficulties in ERCP operation. In the early years, there were repeated trial insertion and blind intubation. Now with the rapid progress of technical experience, it is considered that such operation risk is too high and worthless, so it is no longer used.
At present, the mainstream intubation is to intubate with ERCP guidewire with cutting knife and adjust the direction. ERCP guidewire plays a very important role in intubation. The role of exploratory vanguard has both the function of probing and exploring the road.
After ERCP intubation is successful, ERCP guidewire begins to be inserted into bile duct or pancreatic duct. Of course, ERCP bile duct stent insertion is the most common.
Because the diameter of the bile duct is much larger than that of the pancreatic duct, it usually enters the bile duct naturally. However, there is also the possibility that the ERCP guidewire may enter the pancreatic duct repeatedly after trial, so the elbow guidewire needs to be used for selective insertion into the bile duct.
It has also been proposed that ERCP guidewire should be inserted into the bile duct and retained, and then ERCP guidewire should be placed to insert the bile duct. This situation is called "guidewire space occupying method".
It is also said that when the ERCP guidewire is placed in the pancreatic duct, it straightens the twisted ampullary common channel and corrects the direction of the bile duct to facilitate intubation.
The operation of ERCP guidewire over hilar space occupying (high cholangiocarcinoma) is the most important test of the quality and experience of ERCP guidewire. This operation mainly tests the loach head, toughness and diameter of ERCP guidewire.
Loach head is sensitive and resilient, the higher the toughness is and the smaller the diameter is, the easier it is for the ERCP guidewire to pass through the narrow section. However, you cannot have your cake and eat it too, it is difficult to perfect.
Therefore, the disposable ERCP guidewire with good quality is generally selected to ensure the smooth passage of the guidewire of hilar space occupation.
The method of ERCP guidewire occupying pancreatic duct to assist the second guide wire in intubation of bile duct has been briefly introduced above.
In addition, ERCP guidewire and cutting knife are used to fix the position of nipple, clearly reveal the running direction of bile duct, and assist the incision of nipple sphincter, which can prevent accidental injury or side injury of nipple near diverticulum.
Leo Medical Co., Ltd. was established in October, 2011 and was recognized as a national high-tech enterprise in 2018. It is committed to developing medical equipment, like ERCP devices, to assist in the diagnosis, intervention and treatment of diseases of digestive system, respiratory system and peripheral vascular system. Innovative genes in Leo's blood, through cooperation with medical staff, simplify complex surgery and make impossible surgery possible.
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