tailieunhanh - Gastrointestinal Endoscopy - part 7

Sử dụng chất cản quang được tiêm thông qua một ống thông nhỏ, các ống dẫn mật thông thường, ống dẫn intrahepatic, ống nang và túi mật cũng như các hệ thống ống động mạch tụy có thể được hình dung được soi huỳnh quang. | Chapter 19 ERCP Introduction Equipment Normal Anatomy Gerard Isenberg Introduction Endoscopic retrograde cholangiopancreatography ERCP first reported in 1968 1 encompasses various procedures in the diagnosis and treatment of diseases of the biliary tree and pancreas. Using contrast dye injected via a small catheter the common bile duct the intrahepatic ducts the cystic duct and gallbladder as well as the pancreatic ductal system can be visualized under fluoroscopy. Although it seems straightforward ERCP can be technically challenging because of anatomic variants postoperatively altered anatomy and pathologic changes. Depending on the disease various diagnostic including brush cytology and biopsy and therapeutic including endoscopic sphincterotomy basket extraction of stones and stent placement measures can be performed. ERCP should only be performed by those capable of proceeding with therapeutic interventions. Indications2 and Contraindications Diagnostic ERCP is generally indicated in - Evaluation of the jaundiced patient suspected of having biliary obstruction. - Evaluation of the patient without jaundice whose clinical presentation and biochemical or imaging data suggests biliary tract or pancreatic disease. - Evaluation of signs or symptoms suggesting pancreatic malignancy when results of indirect imaging . ultrasound US computerized tomography CT or magnetic resonance imaging MRI are equivocal or normal - Evaluation of recurrent or moderate to severe pancreatitis of unknown etiology. - Preoperative evaluation of the patient with chronic pancreatitis and or pseudocyst. - Evaluation of the sphincter of Oddi by manometry. Diagnostic ERCP is generally not indicated in - Evaluation of abdominal pain of obscure origin in the absence of objective findings which suggest biliary tract or pancreatic disease. - Evaluation of suspected gallbladder disease without evidence of bile duct disease. - As further evaluation of pancreatic malignancy which has been .