By Peter B. Cotton

The newest version of the world-leading name sensible Gastrointestinal Endoscopy (published in might 2003) has a 'back to fundamentals' procedure - putting emphasis on perfecting the fundamental thoughts of endoscopy. there's now a necessity for designated useful and medical courses to the complex endoscopy thoughts for more matured physicians.

Advanced Digestive Endoscopy: ERCP addresses probably the most advanced diagnostic and healing systems for endoscopists. It offers the most recent pondering and transparent guide at the ideas, which were built-in with total sufferer care.

Written by way of the prime overseas names in endoscopy, the textual content has been expertly edited through 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 pictures.

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Example text

Because of the position of the fluoroscopy machine, the monitors may need to be placed at a 15–20° angle off to the right of the endoscopist for easy observation. The monitors are best ceiling mounted or supported on a stand placed at eye level. The endoscopist should adopt a comfortable position to avoid twisting and turning of the body, which may predispose to scope displacement or straining of the back and neck. The endoscopy tower is usually placed on the right behind the endoscopist, with sufficient room left in between for the manipulation of accessories.

The risk is higher when the pancreas is overfilled, in patients with sphincter of Oddi dysfunction with manometry, and in those with pancreatic manipulation. Cholangitis The risk of cholangitis after ERCP is small, but may occur in patients with bile duct obstruction due to stones or stricture, especially when biliary drainage cannot be established. The risk of sepsis is high in patients with acute cholangitis when the intraductal pressure is raised by excess injection of contrast. The risk can be reduced by aspirating bile before injecting contrast.

The Cambridge Classification is used to document the severity of chronic pancreatitis (Fig. 9) as seen on a pancreatogram: • Mild pancreatitis: a normal main pancreatic duct with three or more abnormal side branches. • Moderate pancreatitis: an abnormal main duct with irregularities in three or more abnormal side branches. • Severe pancreatitis: irregularity with strictures and dilation of the main duct, with filling defects suggestive of stones or filling of cavities or cysts. There is no direct correlation between the radiological abnormalities and the functional loss in chronic pancreatitis because the pancreas has a good functional reserve.

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