GI investigations pt.2

Question 1

What is the purpose of ERCP?

Answer 1

• Provides diagnoses of pancreatic and biliary disease
• Stones can be retrieved from the ducts, biopsies can be performed, strictures can be
  dilated and/or stented, and ductal leaks can be treated
• Usually performed for therapy but is also
  important diagnostically as it facilitates tissue sampling of biliary or pancreatic ductal strictures

Question 2

ERCP indications

Answer 2

• Jaundice
• Postbiliary surgery complaints
• Cholangitis
• Gallstone pancreatitis
• Pancreatic/biliary/ampullary tumor
• Unexplained pancreatitis
• Pancreatitis with unrelenting pain
• Fistulas
• Biopsy radiologic abnormality
• Pancreaticobiliary drainage
• Sample bile
• Sphincter of Oddi manometry

Question 3

How is ERCP performed?

Answer 3

• A side-viewing endoscope is passed through the mouth to the duenum, the ampulla of Vater is identified and cannulated with a thin plastic
  catheter, and radiographic contrast material is injected into the bile duct and pancreatic duct under fluoroscopic guidance
• When indicated, the major papilla can be incised using the technique
  of endoscopic sphincterotomy

Question 4

What is endoscopic ultrasound?

Answer 4

• Utilizes ultrasound transducers incorporated
  into the tip of a flexible endoscope
• Ultrasound images are
  obtained of the gut wall and adjacent organs, vessels, lymph nodes, and other structures
• High-resolution images are obtained by bringing a
  high-frequency ultrasound transducer close to the area of interest via endoscopy

Question 5

Purpose of endoscopic ultrasound in diagnostics

Answer 5

• EUS provides the most accurate preoperative local staging of esophageal, pancreatic, and rectal malignancies, but
  it does not detect most distant metastases.
• EUS is also useful for diagnosis of bile duct stones, gallbladder disease, subepithelial gastrointestinal
  lesions, and chronic pancreatitis
• Fine-needle aspirates and core biopsies of organs, masses, and lymph nodes in the posterior mediastinum,
  abdomen, retroperitoneum, and pelvis can be obtained under EUS guidance

Question 6

Purpose of EUS in therapeutic procedures

Answer 6

They include drainage of abscesses, pseudocysts,
and pancreatic necrosis into the gut lumen ; celiac plexus neurolysis for treatment of pancreatic pain; ethanol ablation of pancreatic
neuroendocrine tumors; treatment of gastrointestinal hemorrhage;
and drainage of obstructed biliary and pancreatic ducts

Question 7

Risks of ERCP

Answer 7

• Pancreatitis occurs in 5% of patients, and young, anicteric (non jaundiced) patients with normal ducts are at increased risk (up to 25%).
• Significant bleeding
  occurs after endoscopic sphincterotomy in ~1% of cases
• Ascending cholangitis, pseudocyst infection, duodenal perforation, and abscess formation may occur as a result of ERCP.

Question 8

Indications for urgent GI endoscopy

Answer 8

• Endoscopy is the primary diagnostic and therapeutic technique for patients with acute gastrointestinal hemorrhage
• GASTROINTESTINAL OBSTRUCTION AND
  PSEUDOOBSTRUCTION (e.g. Esophageal obstruction by
  impacted food or an ingested foreign body is a potentially life-threatening event and represents an endoscopic
  emergency)