ERCP is the acronym for Endoscopic Retrograde Cholangio-Pancreatography (ERCP), which is an endoscopic technique of retrograde visualization of the pancreaticobiliary duct by injecting a contrast agent through the duodenal papilla cannula, and is currently recognized as the gold standard for the diagnosis of pancreaticobiliary duct disease. On the basis of ERCP, interventions such as duodenal papillary sphincterotomy (EST), endoscopic nasal bile drainage (ENBD), endoscopic internal bile drainage (ERBD), and endoscopic lithotomy can be performed, which are popular among patients because they do not require incision, are less invasive, and have a much shorter hospital stay.
Retrograde cholangiopancreatography (ercp)
Transendoscopic retrograde cholangiopancreatography is to insert fiberoptic duodenum to the descending duodenum, find the main duodenal papilla (hereinafter referred to as papilla), insert a plastic catheter into the biopsy duct to the opening of the papilla, inject contrast and then x-ray to show the pancreaticobiliary duct. This method was first reported by mccunne’s in 1968, and later by Ooi et al. The method has become more and more perfect, and in the last decade, with the continuous progress of instruments and intubation techniques, the success rate of ercp has increased year by year, and now it has reached about 90%, becoming an important means of diagnosing pancreatic and biliary tract diseases and an important means of treating common bile duct stones and acute biliary pancreatitis.
I. Indications
1.Cryptocele caused by biliary obstruction.
2, Clinical, laboratory or imaging tests support pancreatic or biliary disease.
3, Symptoms or manifestations suggestive of pancreatic malignancy with ambiguous or normal direct imaging findings.
4.Pancreatitis of unknown cause.
5, Preoperative evaluation of chronic pancreatitis or pancreatic pseudocysts. oddis sphincter manometry.
6. Endoscopic papillary sphincterotomy is required for common bile duct stones, papillary stenosis, sphincter of Oddis insufficiency, Sump syndrome, common bile duct cysts, and jugular carcinoma without surgical indications. Stenting for benign and malignant strictures, sputum ducts, postoperative bile sputum or large common bile duct stones.
7.Placement of balloon dilated nasobiliary drainage tube for bile duct stricture.
8.Pancreatic pseudocyst drainage.
9.Tissue biopsy of pancreatic duct or bile duct.
10.A series of treatment for pancreatic diseases.
II. Contraindications
1.Severe cardiopulmonary or renal insufficiency.
2.Allergy to iodine contrast agent
Preoperative preparation
1. Same as gastroscopy. Perform iodine contrast allergy test.
2. Instrument preparation: duodenoscope, ercp abnormalities (disinfected by soaking in 75% alcohol for 30’～60′). Sterilize syringes, etc.
3. Pre-operative medication: pethidine 50mg intramuscularly, can be injected with buscopan 20mg.
IV. Operation points
1, insertion of the mirror: according to the method of gastroscopy insert the mirror quickly through the gastric lumen, pylorus, into the descending duodenum, this process should be injected as little gas as possible.
2, find the nipple: turn the patient’s body position, prone position is most commonly used, straighten the mirror body, adjust the angle knob, so that the nipple in the upper left of the field of view, identify and align the nipple opening, is the key to successful intubation.
3.Insert the catheter: insert the catheter through the biopsy hole, adjust the angle knob and lift the clamp so that the catheter is perpendicular to the papillary opening, insert the catheter into 1-2 markers to inject contrast, which can show both the pancreatic duct and bile duct, called ercp, and currently advocate selective pancreatic duct (erp) or bile duct (erc) imaging.
4, contrast: inject 2-3ml of 30% bile dextran under fluoroscopy, see the pancreatic duct or bile duct on the fluoroscopy screen, can slowly continue to inject contrast to the desired duct development, the main pancreatic duct development takes about 4-5ml, selective pancreatic duct development should be appropriate to control the dose of contrast used and the pressure of injection, not too much. The filling of the bile duct only requires 10-20 ml, while the complete display of the gallbladder requires 40-60 ml.
5. Radiographs: After pancreatic and bile duct imaging, 1 to 2 films are taken, and then the endoscope is withdrawn, and then different body positions are taken.
V. Postoperative treatment
1. Patients with successful imaging are routinely treated with antibiotics for three days to prevent infection.
2. Observe for fever, abdominal pain, and changes in blood picture.
3. For pancreatic ductography patients, blood and urine amylase should be measured 4-6 hours after surgery and the next morning, and those with elevation should be rechecked daily until normal. And apply octreotide subcutaneous injection or intravenous pump to prevent pancreatitis.
VI. Complications
1, pancreatitis.
2, biliary tract infection DD septic cholangitis.
3, contrast reaction.
4, papillary injury, pancreaticobiliary duct rupture and perforation due to inadvertent operation.
5, other rare complications still include rupture of pseudopancreatic cyst, severe pain in the upper abdomen, abdominal distension, etc.