Why ERCP?
ERCP provides a clear image of the “bile duct tree”, which can identify the cause of jaundice, the location of infarction, the distribution of stones, the location and nature of bile duct strictures, the presence of bile duct malformations, and the early detection of carcinoma of the jugular abdomen. Due to the success of ERCP technology, nasobiliary duct drainage (ENBD), plastic stent (ENBD) and metal stent (EMBE) drainage technology have been developed to play a role in bile duct decompression and yellowing treatment; ENBD can also inject litholytic drugs and antibiotics directly into the bile duct through the catheter for anti-inflammatory treatment, etc.
Indications and contraindications of ERCP
I. Indications.
1.Obstructive jaundice of unknown origin suspected to have extrahepatic biliary obstruction.
2, suspected of various biliary tract diseases such as stones, tumors, sclerosing cholangitis, etc. with unknown diagnosis.
3.Suspected congenital biliary tract abnormalities or recurrence of symptoms after gallbladder surgery.
4, pancreatic diseases: pancreatic tumor, chronic pancreatitis, pancreatic cyst, etc.
5. Early intervention treatment of acute biliary pancreatitis.
II. Contraindications.
1, viral hepatitis in active stage.
2, subacute hepatic necrosis combined with jaundice.
3.Severe cardiopulmonary insufficiency in elderly people over 75 years old without close cardiac monitoring.
4, patients with acute pharyngitis and tonsillitis (currently painless ERCP has solved such problems well).
5, patients with psychiatric disorders.
6. patients with glaucoma and prostatitis should use 654-2 or atropine-type antispasmodics with caution.
7, patients with diabetes mellitus are prohibited to use glucagon as an antispasmodic agent.
8, iodine allergy (have applied iodophoresis instead).
At present, ERCP is a routine examination in the Fourth People’s Hospital of Sichuan Province in general surgery. Our director Li Jinlong has carried out ERCP for ten years and has successfully completed nearly 2000 cases. Minimally invasive surgery is the current direction of surgical development, in terms of biliary and pancreatic diseases, especially in patients with residual bile duct stones after gallbladder surgery, ERCP is a better medical treatment, which avoids the huge trauma caused by open surgery, and also saves medical costs and shortens hospitalization time.
As the incidence of biliary stones due to unreasonable dietary structure has increased significantly, the incidence of biliary pancreatitis has also increased. We have received nearly 100 cases of emergency ERCP + EST within 72 hours after the onset of the disease, which has improved the symptoms of pancreatitis, significantly shortened the course of the disease, significantly reduced complications and significantly reduced costs.
If pancreatic cancer or bile duct cancer causes obstructive jaundice, if they cannot tolerate surgery or have become inoperable, they can all undergo biliary stent placement under ERCP, and the effect of reducing jaundice and survival is comparable to surgery. As long as the jaundice is obstructive, it can basically be resolved by means of ERCP.