Basic ERCP
ERCP is indicated for the evaluation and treatment of _______ and _______ strictures
benign; malignant
True or False: Stones can form in both the gallbladder & the common bile duct
True: 95% form in the gallbladder, 5% form in the common bile duct
T or F: A metal stent will never be removed from a patient
F
A partially covered/uncovered stent can be removed
Cholangioscopy is a minimally invasive procedure used to directly examine the bile ducts with the use of a fiberoptic endoscope for _____ _________ of the biliary tree during ERCP (2 words)
direct visualization
During an ERCP, a ____ viewing scope is used
side
What is the most common complication of ERCP?
Pancreatitis (~5%)
Other complications: bleeding, cholangitis, retroperitoneal perforation, recurrent choledocholithiasis
What is the name of the device we use to sweep stones out of the duct?
Extractor Pro RX
Hilar tumors (Klatskin), the most common malignant biliary stricture, are located where?
Which of the following would not be a disease state examined using cholangioscopy?
A. Choledocholithiasis
B. Biliary Stones
C. Biliary Strictures
D. Pancreatitis
D. Pancreatitis
What is the most common complication of ERCP?
Post ERCP Pancreatitis
What is the name of the duct above the cystic duct & below the bifurcation?
Common Hepatic Duct
What is the name of the disease state for stones found in the common bile duct?
Choledocholithiasis
What is the most common cause of malignant biliary strictures?
Pancreatic Cancer
What is one limitation of early 'mother-daughter' cholangioscopes?
High Repair Costs
Limited Steerability
Poor Irrigation Capabilities
Required 2 Operators
What technique is often used when the physician repeatedly accesses the pancreatic duct?
Double-wire technique
Where does the distal tip of the scope sit when an ERCP is being performed?
Duodenum
______ are constructed of braided wire and advanced through the endoscope to trap stones; whereas _______ are designed to expand the intraductal lumen to facilitate passage of stones by a 'sweeping' action
Baskets; Balloons
10x
What size is the SpyGlass DS II working channel?
1.2mm
On average, what is the diameter of the common bile duct?
4-6mm
What is the working channel size of an ERCP scope?
4.2mm
What 3 letter acronym is used to break up difficult stones using Spyglass?
Electrohydraulic Lithotripsy (EHL)
Name one cause of a benign biliary stricture
Post-Operative Surgery
Liver Transplantation
Primary Sclerosing Cholangitis
Chronic Pancreatitis
What are the 4 accessories we use with Spyglass?
EHL Probe
Spy Snare
Spy Basket
Spybite Max
How much bile does the liver produce each day?
1 Liter