Endoscopic retrograde cholangiopancreatography - Revision history

Chris.Rishel at 05:42, 11 December 2023

2023-12-11T05:42:20Z

← Older revision		Revision as of 22:42, 10 December 2023
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	\| considerations_intraoperative = Consider RSI for pt at high risk of aspiration. Intubation increases likelihood of procedural success.		\| considerations_intraoperative = Consider RSI for pt at high risk of aspiration. Intubation increases likelihood of procedural success.
	\| considerations_postoperative = Pain from procedure is typically minimal. Pancreatitis from ERCP most common complication (1-40% quoted)		\| considerations_postoperative = Pain from procedure is typically minimal. Pancreatitis from ERCP most common complication (1-40% quoted)
	}}		}}'''Endoscopic retrograde cholangiopancreatography''' ('''ERCP''') was originally designed as a purely diagnostic modality, but modern usage is typically for therapeutic purposes. Indications for ERCP include pancreatic or common bile duct obstruction and evaluation of pancreatic malignancy. Success, complication rate and speed of the procedure depends on significantly on operator experience.

	Endoscopic retrograde cholangiopancreatography (ERCP) was originally designed as a purely diagnostic modality, but modern usage is typically for therapeutic purposes. Indications for ERCP include pancreatic or common bile duct obstruction and evaluation of pancreatic malignancy. Success, complication rate and speed of the procedure depends on significantly on operator experience.

	ERCP consists of passing an endoscope from the mouth through the upper GI tract and into the duodenum, where the papilla of Vater is located. The endoscopist may request glucagon and/or secretin at this time to reduce duodenal motility. A guide wire is passed through the sphincter of Oddi into the common bile duct or pancreatic duct. Contrast is then injected to image the common bile duct and pancreatic duct via fluoroscopy. Brushings, samples, stenting, sphincterotomy and/or stone extraction may then proceed. Overall complication rate ranges widely based off of the final procedures and instrumentation of the common bile and pancreatic ducts, with <5% quoted for simple stone extraction and 20% or more with sphincterotomy.<ref>{{Cite book\|last=Jaffe\|first=Richard\|title=Anesthesiologist's Manual of Surgical Procedure\|last2=Schmiesing\|first2=Clifford\|last3=Golianu\|first3=Brenda\|publisher=Wolters Kluwer\|year=2014\|isbn=9781451176605\|edition=2nd\|pages=1512-1515}}</ref>		ERCP consists of passing an endoscope from the mouth through the upper GI tract and into the duodenum, where the papilla of Vater is located. The endoscopist may request glucagon and/or secretin at this time to reduce duodenal motility. A guide wire is passed through the sphincter of Oddi into the common bile duct or pancreatic duct. Contrast is then injected to image the common bile duct and pancreatic duct via fluoroscopy. Brushings, samples, stenting, sphincterotomy and/or stone extraction may then proceed. Overall complication rate ranges widely based off of the final procedures and instrumentation of the common bile and pancreatic ducts, with <5% quoted for simple stone extraction and 20% or more with sphincterotomy.<ref>{{Cite book\|last=Jaffe\|first=Richard\|title=Anesthesiologist's Manual of Surgical Procedure\|last2=Schmiesing\|first2=Clifford\|last3=Golianu\|first3=Brenda\|publisher=Wolters Kluwer\|year=2014\|isbn=9781451176605\|edition=2nd\|pages=1512-1515}}</ref>

Nquach at 21:29, 8 December 2023

2023-12-08T21:29:39Z

← Older revision		Revision as of 14:29, 8 December 2023
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	!System		!System
	!Considerations		!Considerations
	\|-
	~~\|Airway~~
	~~\|ETT required, bite block~~
	\|-		\|-
	\|Cardiovascular		\|Cardiovascular
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	\|Endocrine		\|Endocrine
	\|Glucagon administration may be requested, which is contraindicated in certain rare endocrine tumors such as pheochromocytoma and insulinomas.		\|Glucagon administration may be requested, which is contraindicated in certain rare endocrine tumors such as pheochromocytoma and insulinomas.
	\|-
	~~\|Other~~
	~~\|Check cervical ROM~~
	\|}		\|}

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	* Standard monitors and setup		* Standard monitors and setup
	*Fluoroscopy will be used, ensure adequate radiation safety equipment available (lead apron, lead glasses, lead shield)		*Fluoroscopy will be used, ensure adequate radiation safety equipment available (lead apron, lead glasses, lead shield)
	*Positioning (lateral vs prone) will ~~depending~~ on proceduralist preference and patient factors, have equipment for prone positioning availabe (prone pillow)		*Positioning (lateral vs prone) will depend on proceduralist preference and patient factors, have equipment for prone positioning availabe (prone pillow)
	* Endoscopy will require bite block to facilitate scope passage		* Endoscopy will require bite block to facilitate scope passage

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	*Most patients will be prone for this procedure to aid in manipulation of scope into proper placement.		*Most patients will be prone for this procedure to aid in manipulation of scope into proper placement.
	*If patient cannot tolerate position, lateral or supine positioning can be done (increases difficulty for proceduralist).		*If patient cannot tolerate the prone position, lateral or supine positioning can be done (increases difficulty for proceduralist).

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

Nquach: Filled in article

2023-12-08T21:27:37Z

Filled in article

Show changes

Chuckcampana: Added positioning

2022-08-19T20:13:43Z

Added positioning

← Older revision		Revision as of 13:13, 19 August 2022
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	\| airway = ETT		\| airway = ETT
	\| lines_access = 1 PIV		\| lines_access = 1 PIV
	\| monitors = ~~standard~~		\| monitors = Standard ASA monitors
	\| considerations_preoperative =		\| considerations_preoperative = Aspiration Precautions
	\| considerations_intraoperative =		\| considerations_intraoperative = Most patients should be considered for RSI
	\| considerations_postoperative =		\| considerations_postoperative =
	}}		}}
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	=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===		=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===

			* CBC

	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
	Make sure you have a lead apron available
			* Make sure you have a lead apron available
			* Have a prone pillow available and staff to help turn
			* Have bite block to facilitate scope passage available.

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

			* N/A

	== Intraoperative management ==		== Intraoperative management ==

	=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===

			* Standard ASA monitors

	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

			* RSI

	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
	~~Supine~~
			* Most patients will be prone for this procedure to aid in manipulation of scope into proper placement. If patient cannot tolerate position, lateral or supine positioning can be done (increases difficulty for proceduralist).

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
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	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

			* If obstruction in bile duct is removed, there is a high risk of bile aspiration. Have suction readily available.

	== Postoperative management ==		== Postoperative management ==

Mitchel.DeVita at 08:28, 30 May 2022

2022-05-30T08:28:52Z

← Older revision	Revision as of 01:28, 30 May 2022
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		{{Infobox surgical procedure
		\| anesthesia_type = General
		\| airway = ETT
		\| lines_access = 1 PIV
		\| monitors = standard
		\| considerations_preoperative =
		\| considerations_intraoperative =
		\| considerations_postoperative =
		}}

		Endoscopic approach to access the bile duct utilized to diagnose and treat liver, gallbladder, biliary, and pancreatic problems. Endoscope is inserted from the mouth to duodenum. Then the papilla of vater (Common bile duct outlet) is identified, catheterized, and injected with contrast to identify obstructions.

		== Overview ==

		=== Indications ===
		liver, gallbladder, biliary, and pancreatic pathology

		=== Surgical procedure ===

		== Preoperative management ==

		=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
		{\| class="wikitable"
		\|+
		!System
		!Considerations
		\|-
		\|Airway
		\|ETT required, bite block
		\|-
		\|Neurologic
		\|
		\|-
		\|Cardiovascular
		\|
		\|-
		\|Pulmonary
		\|
		\|-
		\|Gastrointestinal
		\|
		\|-
		\|Hematologic
		\|
		\|-
		\|Renal
		\|
		\|-
		\|Endocrine
		\|
		\|-
		\|Other
		\|Check cervical ROM
		\|}

		=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===

		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
		Make sure you have a lead apron available

		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

		== Intraoperative management ==

		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===

		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
		Supine

		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
		General anesthesia with ETT. TIVA or volatile

		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

		== Postoperative management ==

		=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===

		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
		Pancreatitis

		Cholangitis

		Perforation

		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==

		{\| class="wikitable wikitable-horizontal-scroll"
		\|+
		!
		!Variant 1
		!Variant 2
		\|-
		\|Unique considerations
		\|
		\|
		\|-
		\|Position
		\|
		\|
		\|-
		\|Surgical time
		\|
		\|
		\|-
		\|EBL
		\|
		\|
		\|-
		\|Postoperative disposition
		\|
		\|
		\|-
		\|Pain management
		\|
		\|
		\|-
		\|Potential complications
		\|
		\|
		\|}

		== References ==

		[[Category:Surgical procedures]]

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