By Peter B. Cotton
Advanced Digestive Endoscopy: ERCP addresses probably the most complicated diagnostic and healing strategies for endoscopists. It offers the newest considering and transparent guideline at the innovations, that have been built-in with total sufferer care.
Written by means of the prime overseas names in endoscopy, the textual content has been expertly edited via Peter Cotton right into a succinct, instructive layout. awarded in brief paragraphs based with headings, subheadings and bullet issues and richly illustrated all through with full-color photographs.
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Extra resources for Advanced Digestive Endoscopy: ERCP
Orientation is easier if the patient is in the left lateral (rather than the prone) position. Rotation of the patient into the prone position changes the axis of the stomach, and the tip of the scope often ends up in the fundus. Air is insufﬂated to distend the stomach until an adequate view of the lumen is obtained and to locate the greater and lesser curves. Downward angulation facilitates examination of the lumen and further passage of the endoscope. If the tip of the scope catches against the mucosa, upward angulations will lift the tip away.
Respiratory depression and other complications Adverse drug reactions and respiratory depression due to excess medication may occur. This complication is best prevented by giving sedation slowly in small increments, and by assessing the overall response of the patient. Proper monitoring of blood pressure, pulse, and oxygenation helps to avoid this complication. The use of oxygen at 2 liters/min given via a nasal catheter helps to prevent hypoxia. Glucagon may increase the blood sugar level in diabetic patients and the anticholinergic effect of Buscopan may cause tachyarrhythmia.
It is important to synchronize your push with the patient’s swallow. If in doubt, rule out any obstructing factors with a forward-viewing endoscope. In rare cases, it may be necessary to guide the scope with the left index ﬁnger in the oropharynx. Lost in the stomach Negotiating the stomach with a side-viewing duodenoscope is sometimes confusing. A side-viewing endoscope can function like a forward-viewing endoscope if the tip is deﬂected downwards. Orientation is easier if the patient is in the left lateral (rather than the prone) position.