Endoscopy Master Videos: ERCP Precut with a short nose sphincterotome @ www.gastroliver.com.sg скачать в хорошем качестве

Endoscopy Master Videos: ERCP Precut with a short nose sphincterotome @ www.gastroliver.com.sg

When selective biliary cannulation fails due to anatomical reasons, precut sphincterotomy is a technique used to gain access to the bile duct. Many techniques have been described but these are variations of basically 3 techniques: (1) needle knife method, (2) a short nose sphincterotome in the papilla orifice, (3) trans-pancreatic septotomy with the sphincterotome tip in the pancreatic duct. The technique demonstrated is the use of a short nose sphincterotome in the papillary orifice. This is useful in anatomical variants with a long intra-duodenum ampullary segment or a "floppy" papilla when deep cannulation is unsuccessful. A pull-type sphincterotome with a short nose is engaged in the papilla orifice and bowed. Step-wise incision is performed in the 11 o'clock direction until the salmon pink colored mucosa of the common channel is exposed. The incised papilla opens up like a book, exposing the common channel. The upper limit of the incision is the transverse fold "hood" over the papilla or where the papilla bulge meets the duodenum wall. The area is then gently probed with a soft tip catheter or the sphincterotome to locate the biliary orifice which is usually at the uppermost part of the incision.