ASGE Masterclass: Endoscopic Retrograde Cholangiopancreatography (ERCP) On-Demand | January 2022-5_Faulx ERCP cannulation ASGE masterclassFINAL (1).pdf

5_Faulx ERCP cannulation ASGE masterclassFINAL (1).pdf

Pdf Summary

This document provides information on cannulating the desired duct during endoscopic retrograde cholangiopancreatography (ERCP) procedures. It discusses various methods for biliary and pancreatic cannulation, as well as techniques for minimizing complications.<br /><br />The document starts by outlining the three steps involved in cannulation: understanding the anatomy, positioning the papilla correctly, and selecting the appropriate tools and techniques.<br /><br />It then discusses the different tools available for cannulation, such as catheters and sphincterotomes, and provides tips for their selection. It also mentions the use of guidewires in guiding cannulation and discusses the mixed data on its effectiveness.<br /><br />The document highlights the importance of minimizing complications during ERCP and identifies several factors that increase the risk of complications, such as precut sphincterotomy and pancreatic injection. It also mentions the effectiveness of prophylactic pancreatic stenting in reducing the risk of post-ERCP pancreatitis.<br /><br />The document provides tips for successful cannulation, such as targeting specific orientations, using straight or tapered tip catheters, and occluding the bile duct with a stent. It also discusses the importance of patient selection and risk stratification to determine the most appropriate interventions.<br /><br />Furthermore, the document reviews the use of pharmacological prophylaxis, such as rectal indomethacin, to prevent post-ERCP pancreatitis. It also highlights the role of aggressive intravenous fluid administration in reducing the incidence and severity of complications.<br /><br />The document emphasizes the need for expertise and proficiency in techniques such as needle knife sphincterotomy and directed pancreatic duct cannulation. It suggests referring to video resources for further guidance.<br /><br />In conclusion, the document provides comprehensive information on cannulating the desired duct during ERCP, including various techniques, tools, and tips to minimize complications. It emphasizes the importance of patient selection, risk stratification, and proper training in achieving successful outcomes.

Keywords

cannulation

endoscopic retrograde cholangiopancreatography

ERCP procedures

biliary cannulation

pancreatic cannulation

complications

tools and techniques

guidewires

post-ERCP pancreatitis

pharmacological prophylaxis