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ERCP

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Update on ERCP

Endoscopic retrograde cholangiopancreatogram, as the name implies is an endoscopic treatment for biliary and pancreatic disorders. It is a day care procedure.


The procedure

The procedure involves the stone, cannulation of CBD selectively. This is achieved with sphincterotome and CBD stone guidewire. We at VGM, house a large variety of guidewires and sphincterotomes. After cannulating the ampulla, cholangiogram revels the presence of stone, stricture or leak. Then balloon sweeps and dilation are done as and when required. The stone can be removed using balloo, metallic basket, or crused using lithotriptor. In lithotripsy can be done via spyglass cholangioscope which is used to pulverise the stone, then the fragments can be removed by balloon sweeps. When none of these techniques are feasible to remove the stone, it can be pulverised using ESWL. Quantum biliary balloon and CRE balloon dilation are used to dilate strictures.


Indications:

Billiary Disorders

1. CBD stone (gall stone slipping into CBD),
2. Benign biliary strictures
3. Periampullary Carcinoma for palliation
4. Cancer head of pancreas with obstructive jaundice for palliation
5. Hilar cholangiocarcinoma
6. Post-op billiary leak.
7. The patients generally present with obstructive jaundice with high coloredurine and pale colored stools, itching, fever and abdominal pain.


Pancreatic Disorders :

1. Chronic pancreatitis with PD stricture or PD stone,
2. Duct disruption inacute on chronic pancreatitis.
3. Rarely for pancreas divisum


30 years of experience in the field

When Cannulation fails, as it is quite possible in novices, Dr.VGM uses techniques gathered from 30 years of practice, picked up from all over the world, which are highly effective and very rewarding. He uses a further huge aramamentarium of precut techniques, needle knife tome to facilite cannulation. Another frequent consequence of ERCP pancreatitis. Our center boasts of the least rate of post ERCP pancreatitis, due to excellent preventive measures taken by our anesthetist and endoscopist team.