Ercp- for Beginners
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The document discusses risk factors and complications of endoscopic retrograde cholangiopancreatography (ERCP). It identifies the locations of the major and minor pancreatic papillae. Patient factors like previous pancreatitis, younger age, and normal bilirubin levels increase risk. Procedural risks include long cannulation time, needle-knife precut, sphincterotomy, and multiple wire passes. Common complications are hyperamylasemia without symptoms and acute pancreatitis from papillary trauma, edema, or bleeding during access attempts. Needle-knife, precut sphincterotomy, and suprapapillary puncture are techniques to facilitate cannulation or access.
Ercp- for Beginners
- 4. The major papilla- 11-12 o’clock position Minor papilla - 5 - 11 o’clock position
- 5. Patient related- Previous PEP, younger age, female sex, normal serum bilirubin levels, and history of acute recurrent pancreatitis, Procedure related- Frequent PD visualization, cannulation time >10 min, needle-knife precut, pancreatic sphincterotomy, pancreatic duct stent implantation and ≥1 pancreatic deep wire pass. Operator-related
- 6. Hyperamylasemia without clinical symptoms after ERCP is more common than pancreatitis, occurring in 6.8–70%
- 7. Leads to edema Papillary trauma Inability to achieve deep ductal access Bleeding Perforation Pancreatitis
- 9. Catheters Papillotomes Guide wires in conjunction with catheters and papillotomes Placement of pancreatic stent or guide wire to facilitate cannulation
- 10. Precut papillotomy (needle knife papillotomy) Transpapillary pancreatic sphincterotomy (precut pancreatic sphincterotomy) Suprapapillary puncture of the common bile duct (needle knife fistulotomy)