Download - Kuliah Blok GI Tract-ERCP , Agustus 2010
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
1/15
Endoscopic, Retrograde CholangioPancreatography/ERCP
Dr. Yanto Budiman, Sp.Rad., M.Kes
Bagian Radiologi FK/RS Atma Jaya
Jakarta
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
2/15
ERCPEndoscopic, Retrograde Cholangio Pancreatography Endoscopic :use of an instrument called an endoscope - a
thin, flexible tube with a tiny video camera and light on the
end. Retrograde :The direction in which the endoscope is usedto inject a liquid enabling X-rays to be taken of the parts ofthe GI tract called the bile duct system and pancreas.
The process of taking these X-rays is known as
cholangiopancreatography. Cholangiopancreaticography :Imaging the bile ductsystem, and pancreas.
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
3/15
Indications for imaging
Gallstones, which are trapped in the main bile duct
Blockage of the bile duct
Jaundice Undiagnosed upper-abdominal pain
Cancer of the bile ducts or pancreas
Pancreatitis
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
4/15
When pancreatitis is caused by gallstones, it isnecessary to remove the gallbladder.
At times, an ERCP (Endoscopic RetrogradeCholangioPancreatography) test is recommended.This involves passing a flexible tube through themouth and down to the small intestine. A smallcatheter is then inserted into the bile duct to see ifany stones are present. If so, they are thenremoved with the scope.
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
5/15
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
6/15
Preparations Patients should ingest no solids for at least 6-7 hours and
no liquids for at least four hours prior to the procedure. For some procedures, topical pharyngeal anesthesia alone
is sufficient, especially when the endoscopy is performedwith a small diameter endoscope. For prolonged examinations, those in children, or in
patients with a high degree of anxiety, rapid onset sedativesand/or analgesics are often necessary.
Anticholinergics (e.g., atropine) have been given todecrease saliva, gastric secretions and motility, and reducethe likelihood of vasovagal reactions; For procedures in
which paresis of gastroduodenal motility is necessary,parenteral glucagon may be useful
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
7/15
Basic Procedure
The throat is anesthetized with a spray or solution The endoscope is then gently inserted into the upper esophagus. The
patient breathes easily throughout the exam, with gagging rarelyoccurring.
A thin tube is inserted through the endoscope to the main bile duct
entering the duodenum. Contrast media is then injected into this bile duct and/or thepancreatic duct and x-ray films are taken.
The patient lies on his or her left side and then turns onto the stomachto allow complete visualization of the ducts.
If a gallstone is found, steps may be taken to remove it. If the duct has
become narrowed, an incision can be made using electrocautery(electrical heat) to relieve the blockage, it is possible to widennarrowed ducts and to place small tubing, called stents, The exam takesfrom 20 to 40
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
8/15
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
9/15
Side Effects and Risks
A temporary, mild sore throat sometimes occurs after theexam. Serious risks with ERCP are uncommon. One suchrisk is excessive bleeding, especially when electrocautery isused to open a blocked duct.
In rare instances, a perforation or tear in the intestinal wallcan occur. Inflammation of the pancreas also can develop.
There is also a small risk of an allergic reaction to the dye,which contains iodine. Rarely, drugs used to relax theampulla of Vater can have side effects such as nausea, dry
mouth, flushing, urinary retention, rapid heart rate (sinusor supraventricular tachycardia), or a drop in bloodpressure
Due to the mild sedation, the patient should not drive oroperate machinery for six hours following the exam.
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
10/15
Contrast Media 20 ml non-ionic/low-osmolality 200 mg/ml contrastmedia
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
11/15
ERCP
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
12/15
Magnetic resonance cholangiopancreatography
(MRCP)When compared to ERCP or PTC the accuracy is
very similar. MRCP has a sensitivity and specificityof 91% and 98% respectively for
choledocholithiasis . Its accuracy for benign and malignant obstruction
is 90%.
Does not carry the 5 - 30% failure rate associatedwith ERCP . It is also spares the morbidity (1-7%)and mortality (0.2-1%) of ERCP and is twice as costeffective .
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
13/15
The disadvantage is that it is solely a diagnostictest.
It should not be used in choledocholithiasis whenthere is a high likelihood of a CBD stone. In thissituation ERCP would be indicated sinceendobiliary therapy can also be carried out. MRCP
is not the initial investigation of choice incholecystitis as ultrasound is just as accurate andmuch more cost effectiv
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
14/15
-
8/3/2019 Kuliah Blok GI Tract-ERCP , Agustus 2010
15/15
THANK YOU