Endoscopic sphincterotomy (EST)

Endoscopic papillary sphinctertomy (EST) is a further development based on the diagnostic technique of endoscopic retrograde cholangiopancreatography. The duodenum is treated with a high-frequency electric incision under endoscopy. A treatment technique for the incision of the end of the sphincter and the common bile duct. Before the operation, the iodine allergy test should be performed. The patient needs an empty stomach. The upper part of the throat is required for local anesthesia according to the upper gastrointestinal endoscopy. Valium 5 mg, Dolantin 50 mg and Buscopan 20 mg can be intravenously administered 10 min before surgery. Basic Information Specialist classification: Digestive examination classification: endoscope Applicable gender: whether men and women apply fasting: fasting Tips: Before surgery, you need to understand the patient's coagulation status, and correct it if necessary to reduce the incidence of bleeding complications after incision. Patients with severe cardiopulmonary dysfunction may be difficult to tolerate due to the need to take a prone position during the procedure. Normal value After endoscopic sphincter sphincter incision, combined with gravel, stone removal, aphid removal, nasal bile duct drainage, internal stent drainage, etc., the disease can be partially or completely treated. Clinical significance Abnormal results: The incision was unsuccessful. Need to check the crowd: common bile duct stones, biliary pancreatitis, acute obstructive suppurative cholangitis, periampullary tumors, biliary tract mites, benign biliary end benign stenosis, Oddi sphincter dysfunction and other diseases. Precautions Taboo before inspection: 1. It is necessary to understand the patient's coagulation status before surgery, and correct it if necessary to reduce the occurrence of bleeding complications after incision. 2. 10 minutes before surgery, intravenous injection of Valium 5mg, Dolantin 50mg, Buscopan 20mg, according to the individual differences in patients, the type of medication and the amount of medication for individual adjustment. Taboo when checking: 1. Patients with severe cardiopulmonary dysfunction may be difficult to tolerate due to the need to take a prone position during the procedure. 2. During the operation, the patient's blood oxygen saturation and vital signs should be monitored, and if necessary, oxygen should be taken to prevent hypoxemia. Inspection process 1. Before the operation, the iodine allergy test should be performed. The patient needs to have an empty stomach. The upper part of the throat is required for local anesthesia according to the upper digestive tract endoscopy. Valium 5 mg, Dolantin 50 mg and Buscopan 20 mg can be intravenously administered 10 min before surgery. 2. Before the incision, ERCP is performed first: Under the duodenal endoscope, the incision can be directly intubated to perform angiography on the common bile duct to establish an accurate diagnosis and whether to make a final evaluation of the EST. 3. Insert the insulated guide wire into the common bile duct from the catheter channel of the incision knife to prevent the incision process from being able to enter the bile duct after the knife is slid out, and to ensure the accuracy of the incision route. 4. Paste the negative electrode plate of the high-frequency electric generator on the skin of the patient's buttocks, and connect the connecting joint of the cutting knife control handle with the corresponding electrode connector of the high-frequency electric generator. After connecting various devices, the cutting will be performed. Open the knife and exit the common bile duct. According to the specific circumstances, the assistant will tighten the cutting knife wire into a bow shape, push the first 1/3 of the steel wire into the nipple, adjust the tightness of the steel wire, and use the endoscopic instrument lifter. And the left-handed endoscope body and other comprehensive adjustment, so that the cutting knife wire along the nipple opening 11 o'clock direction, pulse cutting slowly the top of the nipple, and cut the nipple sphincter to the required and possible incision size, often 1.0 Cm-1.5cm. Not suitable for the crowd Not suitable for people: no Adverse reactions and risks Nothing.