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KADA DA, A KADA NE ERCP

KADA DA, A KADA NE ERCP. Prof.dr.sc.Žarko Babić KB Dubrava, Zagreb Klinika za unutarnje bolesti Zavod za gastroenterologiju Odjel za gastroenterologiju. Indications. Evaluation of chronic pancreatitis Recurrent cholangitis

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KADA DA, A KADA NE ERCP

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  1. KADA DA, A KADA NE ERCP Prof.dr.sc.Žarko Babić KB Dubrava, Zagreb Klinika za unutarnje bolesti Zavod za gastroenterologiju Odjel za gastroenterologiju

  2. Indications • Evaluation of chronic pancreatitis • Recurrent cholangitis • Evaluation of possible cancer of the biliary tree and/or pancreas • Choledocholithiasis (ductal stones) • Removal of retained bile or pancreatic stones • Pre- or post-operative cholecystectomy when ductal stones are suspected • Chronic or acute abdominal pain when bile duct disease is suspected

  3. Indications • Suspected primary sclerosing cholangitis (PSC) • Evaluation of abnormal biliary system findings from a CT, EUS or MRCP • Obstructive jaundice • Dilated CBD (common bile duct) • Tissue sampling

  4. Indications • Biliary strictures • Sphincter of Oddi dysfunction • Palliative or pre-operative stenting of malignant biliary or pancreatic strictures • Treatment of bile leaks (biliary ducts or pancratic duct) • Pancreatic fluid colections (pseudocysts and necrosis-that communicate with pancreatic duct)

  5. Indications-conclusion • TODAY: Therapeutic ERCP • Always is indicated in: -Conditions that need immidiate attention and resolution (diagnostic, therapeutic-papilotomy, dilatation, drainage, stenting, ampulectomy etc.) -Bile duct (pancreatic duct) dilatation with laboratory signs of cholestasis (bilirubin, GGT, ALP)

  6. Contraindications • MAJOR: • The risk of sedation • GENERAL: • Recent myocardial infarction • Visceral perforation, Risk of perforation • (some duodenal diverticula, anatomyc abnormalities) • Recent barium enema-superposition • Who cannot cooperate • RELATIVE: • 1) Patient’s needs vrs. Patient’s current condition (eg.: may be unstabile due to an infection that is resolved with procedure-biliary sepsis) • 2) Coagulopathy (correction !)

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