Advanced Pancreaticobiliary Endoscopy by Douglas G. Adler

By Douglas G. Adler

This quantity offers a finished advisor to complicated endoscopic tactics and strategies. essentially enthusiastic about Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Ultrasound (EUS), the e-book additionally explores similar themes resembling cholangioscopy, pancreatoscopy, complex pancreaticobiliary imaging, stenting, and endoscopic capacity to accomplish soreness keep watch over. The textual content additionally provides a plethora of advice and methods on easy methods to practice those techniques accurately, emphasizes universal blunders and the way to prevent them, and lines top of the range movies illustrating key procedural points for each chapter.
Written by way of most sensible specialists within the box, Advanced Pancreaticobiliary Endoscopy is a useful source for gastrointestinal endoscopists and fellows drawn to complicated endoscopic procedures.
  
 

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5 min, although the ideal amount of time required is unknown) [63]. After dilation, the balloon should be deflated until it is completely flat and withdrawn from the endoscope (Fig. 7b). The guidewire should be left in place to facilitate access in case of any adverse event occurs. Additionally, fluoroscopy should be used to ensure that there is no free air in the abdomen. Adverse events such as perforation can occur if the stone is incarcerated in between the bile duct wall and dilation balloon [63].

The use of a gastroscope or a colonoscope to map out the “lay of the land” prior to duodenoscope insertion is helpful in identifying any unexpected anatomic variations as delineating the afferent from the efferent limb. Once the afferent limb is identified, it can be marked in several ways. A guidewire can be left in place; India ink tattooing or endoclip placement at the site of the anastomosis can all help in easy identification of the afferent limb prior to duodenoscopy [93, 94]. Once the major papilla has been reached and when using a duodenoscope, biliary cannulation should be attempted 2 Endoscopic Management of Large and Difficult Common Bile duct Stones 29 toward the 5 o’clock position (reverse angle approach) [93].

The energy from the shock waves is transmitted to and through the adjacent stones, resulting in their fragmentation (Fig. 6) [5, 11]. During the procedure, continuous saline irrigation of the bile duct is necessary to assure visualization and removal of the stone fragments. Saline also provides a medium for shock wave energy transmission [13]. If the bipolar probe is deployed near the duct wall or away from stone, the hydraulic shock waves could cause inadvertent injury or perforation of the bile duct [5, 11].

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