Endoscopy - ERCP Procedure - Radiologic Tech Guide

Tuesday, January 6, 2015

Endoscopic Retrograde Cholangiopacreatography (ERCP) - this endoscopic procedure is used to diagnose a pathology in the biliary and pancreas. It is useful in diagnostic method when the biliary ducts at the ampulla are not obstructed and dilated.
Flouroscopy is used to perform the ERCP by passing a fiberoptic endoscope through the mouth into the duodenum. Local anesthesia is sprayed in the throat of the patient that causes temporary paresis of pharyngeal to ease the passage of the endoscope, food and drinks are prohibited for at least 1 hour after the procedure. After the procedure, the patient food may be withheld for up to 10 hrs. to minimize irritation to the stomach and small intestine.

The endoscopy technician locates the hepatopancreatic ampulla (ampulla of vater), a small cannula is inserted through the endoscpe and directed into the ampulla.
endoscopy
Left Lateral Position: Cannulation Procedure

Once the cannula is place properly, the contrast medium is injected into the common bile duct. Perform fluoroscopy and take spot radiograph as patient is positioned.

Oblique Spot Film Radiograph:
To prevent overlap or superimposition of the common bile duct and the pancreatic duct.
Note: The injected contrast media will drain from normal ducts within approximately 5 minutes, spot film must be taken immediately.
endoscopy
Spot Film PA Projection
The contrast medium that is used will depend on the preference of the radiologist or gastroenterologist. Dense contrast agents opacify small duct, but may obscure some small stones. A more diluted contrast is recommended. A sensitivity test history of a patient is not necessary it's use for ERCP. However patient must be watched carefully for a reaction to the contrast media used during ERCP.
The ERCP procedure is usually indicated when both clinical and radiographic findings indicated abnormalities in the biliary system and pancreas.

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