Endoscopic Retrograde Cholangiopancreatography (ERCP)

Insert the endoscope into the descending segment of the duodenum, find the duodenal papilla, and insert a plastic contrast tube into the nipple opening from the biopsy channel. Unexplained obstructive jaundice, especially in general biliary tract, gallbladder angiography. Basic Information Specialist classification: Digestive examination classification: endoscope Applicable gender: whether men and women apply fasting: fasting Tips: Check the day before dinner for fasting. Acute pancreatitis or acute exacerbation of chronic pancreatitis; severe biliary tract infection; iodine allergy; those with cardiopulmonary insufficiency and other endoscopic contraindications are not suitable for this test. Normal value normal. Clinical significance Indications: 1, obstructive jaundice of unknown cause, especially in the general biliary tract, gallbladder angiography. 2, suspected of having cholelithiasis and X-ray failed to confirm. 3. Malignant tumors of the liver, gallbladder, and pancreatic system. 4, suspected of having a variety of pancreatic cysts. 5, X-ray or endoscopy is suspected of external compression from the stomach or duodenum. 6, suspected of chronic pancreatitis or diabetes caused by pancreatic cancer. 7, symptomatic duodenal papillary diverticulum. 8, there is symptoms of upper abdominal discomfort, but routine examination failed to confirm the presence of stomach, duodenum, liver lesions, suspected pancreatic disease. High results may be diseases: chronic cholangitis, bile duct stones and cholangitis, biliary tract stenosis, bile duct stones, biliary ascariasis and hepatic ascariasis, pancreatic division, iatrogenic bile duct injury, annular pancreas, peripheral ampullary carcinoma Precautions Preparation before inspection: 1. Do an iodine allergy test. 2, do white blood cell count and serum or urine amylase determination. 3. Check the day before dinner for fasting. 4, subcutaneous injection of atropine 0.5mg, stable 5mg ~ 10mg. Oral defoamer, such as silicone oil 3 ~ 5ml, and for local anesthesia of the throat. Requirements for inspection: Eliminate the tension with the doctor's request. Inspection process (1) The patient is placed in the left lateral position, the endoscope is inserted into the esophagus, and slowly passed through the stomach into the descending segment of the duodenum, and the mirror body is rotated 90 to 120 degrees to find the nipple. The nipple is usually located at a depth of about 80 cm, and is mostly located on the left side wall of the middle part of the descending segment of the duodenum. It is a reddish-elliptical bulge that protrudes into the intestine. If the bile duct and the pancreatic duct together open on one nipple, the bile duct opening is often higher than the pancreatic duct opening. If the two tubes are respectively opened on the respective nipples, the common bile duct nipple is also higher than the pancreatic duct nipple. (2) Insert a nylon catheter from the nipple opening, and insert the bile duct from the bottom to the top for easy development; the vertical insertion of the front surface facilitates the development of the pancreatic duct. The depth of the catheter should not exceed 10mm. If it is too deep, it will only be developed by one pipe. If it is too shallow, it will be easy to escape. (3) The resistance disappeared after the catheter was inserted. A 20 ml syringe was attached to the end of the catheter and the warmed contrast agent was slowly injected under fluoroscopy. Pay attention to controlling the injection speed, pressure and dose. The speed is 1ml per minute, and the cholangiography can be slightly faster. Usually pancreatic ductography is performed first, followed by cholangiography, and both can be developed at the same time, or only one of them can be seen. (4) After the bile duct is filled, the head is lowered to a high level, and the upper bile duct and the left and right hepatic ducts are filled. Observe the supine or standing position in the lower part of the common bile duct. Fill the pancreatic duct and take the left lateral position first, then change to the prone position and supine position. (5) Injecting 2 ml of contrast medium to develop all pancreatic ducts, and immediate filming is required. The contrast agent is discharged by itself within 1 to 2 minutes in the pancreatic duct. If the injection of the contrast agent is slightly responsive, a small amount of 0.5 ml may be injected to develop the pancreatic duct branch. The contrast agent should not be injected too much, so as to avoid the development of the glandular area, overlap with the pancreatic duct and be unclear, and easily cause post-contrast pancreatitis. (6) Under the perspective, it is considered to be full of satisfaction, that is, to fill the image. After the photograph is satisfactory, the endoscope is taken out, and the film is taken again to further observe the portion overlapping with the endoscope. If the obstruction is suspected, 30 and 60 min tablets should be taken to observe the emptying of the contrast agent. If the main pancreatic duct is not emptied for 30 minutes, the common bile duct is not emptied for 30 to 60 minutes, suggesting that there may be obstruction. (7) Complications: The incidence rate is about 3%. Common complications are caused by excessive filling of the pancreatic duct, such as cholangitis, hemorrhagic pancreatitis, nipple and bile duct injury, and sepsis. The movement must be gentle during the contrast operation. After the end of the angiography, an appropriate amount of penicillin and streptomycin can be injected and then the tube can be removed to prevent complications. (8) Postoperative treatment: serum amylase should be checked 4h~6h after operation, if more than 200 units, accompanied by abdominal pain and fever, should be treated according to acute pancreatitis. If only amylase is elevated, it should be reviewed daily until normal. Semi-liquid diet for 2 days to 3 days. After the angiography, antibiotics were given for three days to prevent infection. Not suitable for the crowd Acute pancreatitis or acute exacerbation of chronic pancreatitis, severe biliary infection, iodine allergy, cardiopulmonary insufficiency and other endoscopic contraindications. Adverse reactions and risks Common complications are caused by excessive filling of the pancreatic duct, such as cholangitis, hemorrhagic pancreatitis, nipple and bile duct injury, and sepsis.