therapeutic manoeuvres

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Therapeutic manoeuvres during ERCP include:

  • gallstone removal with sphincterotomy:
    • a basket or balloon permits the removal of stones up to 2 cm in diameter
    • the bile duct can be cleared in 80% of patients
    • sphincterotomy enlarges the lumen of the ampulla and facilitates the spontaneous passage of gallstones

  • dilatation of benign biliary strictures

  • stenting:
    • indicated for palliation of bile obstruction in malignant disease
    • stenting involves the passage of a guide wire, followed by a cannula
    • the stent is 'railroaded' over the cannula
    • symptoms such as pruritus usually resolve within 12 hr but jaundice takes longer to improve
    • plastic stents become clogged with bilirubin pigment and may need changing after an average of 4 months; expensive, self-expanding metal stents probably last longer
    • stenting is successful in about 70% of patients with cancer of the head of the pancreas, where an open operation previously had a 10-30% mortality within 30 days of surgery

Last reviewed 01/2018