Prepare and monitor the patient for endoscopic retrograde cholangiopancreatography

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Posted by Master, Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital

Endoscopic retrograde cholangiopancreatography (ERCP) is performed by a gastroenterologist or surgeon who has specialized training in this technique. The bronchoscope is a long, flexible tube with a light and camera on the end. Because the procedure involves sedation or general anesthesia, the patient will be consulted by an anesthesiologist before the procedure.

1.Prepare the patient

Preparing the patient for endoscopic retrograde cholangiopancreatography is straightforward. Patients need to fast and not put anything in their mouth including liquid for at least 6-8 hours before the procedure. It is customary to prepare a patient for endoscopic retrograde cholangiopancreatography. If performed in the morning, do not give the patient anything to eat from midnight. But if the procedure is performed in the afternoon, it may allow the patient to drink liquids early in the morning and then eat nothing after 8:30 a.m. Patients should also be allowed to take medications if they must take them within 2g of the procedure (with very little water, of course). This requires emphasis and attention because the procedure often involves the use of intravenous anesthetic.

The patient needs to be given fluids in the ward, the line should be placed in the left hand before bringing the patient to the endoscopy room on time. In patients who are not severely ill (endoscopic retrograde cholangiopancreatography), so that the patient does not feel stress on the path of transfer, intravenous injection with a needle should be given. When lying on the endoscope, then attach the infusion. When doing this, consider the patient's cardiopulmonary status and other metabolic conditions such as diabetes and high blood pressure. This not only controls dosing but also prevents delays in starting the procedure because of the need to administer injections for fluids in the endoscopy room. In the procedure, it is necessary to combine pain relief injection in the muscle before taking the patient from the ward to the endoscopy room. In order for the patient to be more relaxed, less anxious, and more cooperative, preoperative analgesia is required. If this is done well, the conditions required for intravenous analgesia will be reduced. Recently, however, anesthetics are becoming less and less toxic, awakening is quick and patients are less struggling during endoscopic retrograde cholangiopancreatography in difficult situations, the author has used general anesthesia and Finding that the patient was at rest, the Endoscopist performed the technique less stressfully and the success rate increased. Patient position When the patient is brought into the endoscopy or radiology room, the patient is placed on the endoscope in the left side lying position. This pose, along with the right hip (P) cross, is slightly raised. The patient is more comfortable if the foot (P) rests on a pillow in a pillow-hugging position. In general, this position helps to position the hepatopancreas-biliary tract more favorable for fluorescein examination and also allows the endoscopist to easily place the duodenum bronchoscope with little coordination. skillfully or change the patient's position. Before the advent of wide-angle endoscopes, the insertion of the endoscope into the duodenum was performed with the patient in the left lateral position similar to the usual position for upper gastrointestinal endoscopy

This position theoretically allows for easier maneuvering when the bronchoscope tip passes through the pylorus into the duodenum. After entering the duodenum, roll the patient into a more prone position. This procedure requires the assistance of a technician because the patient has been given pre-anesthetic or endotracheal anesthesia. This position can facilitate the insertion of the endoscope into the duodenum. Currently, when the patient is on the endoscope or radiographic table, a special position is to lie on the left side (T) slightly prone. The right buttock (P) is higher, the leg (P) flexes to determine if the barium has been eliminated. If the barium is still readable on radiographs, the appointment of an appropriate enema the previous afternoon will ensure that the biliary-pancreatic area that is to be examined by endoscopy does not overlap, otherwise the lesion will be missed. in the biliary-pancreatic tract just for this reason

Pain relief, conscious pain control Although there are many good antispasmodic, analgesic and anesthetic drugs, doctors often use 2 things Buscopan 5mg and Valium 10mg TM. These drugs are dosed to the extent that analgesia is consciously sedated but with the complete cooperation of the patient. Recently, with critically ill patients, comatose patients require endotracheal anesthesia with the help of anesthesiologists as well as many newer pre-anesthetic drugs. Since then, all anesthetics and anesthetics used for patients with endoscopic retrograde cholangiopancreatography are completely decided by the anesthesiologist. Careful physical exploration can be combined with mechanical testing such as BP measurement, cardiac probe, pulse oximetry. This is very important and necessary for the safe endoscopic retrograde cholangiopancreatography. Anesthesiologists on duty when performing endoscopic retrograde cholangiopancreatography require close exploration, especially in at-risk patients. Pulse oximetry (Sp0)) is not currently mandatory, but it can be of great help in probing the patient's vital signs.
However, probes are not a complete substitute for visual monitoring and clinical examination. Intranasal oxygen has become more routine and helps maintain satisfactory oxygen saturation, especially in elderly patients to avoid unresponsiveness after the first dose of sedative analgesia. The antispasmodic Glucagon has long been the standard drug for anti-motility because the antispasmodic effect of glucagon is very good and it has been found that a dose of less than 1mg of Glucagon still has the same effect as a dose of 1g. . It is possible to repeat injection but the total dose should not exceed 0.5g if there is a case of long-term retrograde cholangiopancreatography. After inserting the bronchoscope through the duodenum, the assistant usually administers 0.25g of Glucagon to the infusion fluid. In addition, Atropin may be necessary in patients with duodenal spasm but poorly responding and is currently rarely used while other antispasmodics such as Buscopan, Cystabon ... although not as good as Glucagon, Cheap and widely used.

2.Patients will be monitored by monitoring during the procedure

All these drugs can affect blood pressure so it is best to monitor the patient's vital signs during the procedure. All patients, especially the elderly, because prolonged prone position can lead to hypoxemia, It is only recently that some potential dangers of intravenous analgesia have begun to be recognized. patients undergoing endoscopic cholangiopancreatoscopy, which occurs mostly in elderly patients.
Although these additional probes are not part of the standard requirements for endoscopic cholangiopancreatography, monitoring is recommended for general use because many therapeutic procedures are performed in elderly patients who are placed in the prone or nearly prone position for long periods of time. Therefore, careful exploration and strict adherence to the strict indications for endoscopic retrograde cholangiopancreatography should be followed by good patient preparation and a thorough examination of all endoscopic probes and instruments. The ablation machine before the start of the procedure not only provides good prevention of possible complications for the patient, but also helps the endoscopist to have success during the procedure.
Performing ERCP procedure at Vinmec International General Hospital allows endoscopic diagnosis and treatment under sedation safely, helping patients no longer fear endoscopy with the most modern technical machines; The Department of Endoscopy is designed for patient privacy, comfort and safety. In addition, strict adherence to the principles of sterilization and disinfection is required to prevent the spread of pathogens through endoscopes to patients and medical staff. Fully equipped with facilities and equipment to allow endoscopic diagnosis and treatment under sedation, helping patients not feel pain and stimulation when performing the procedure; The ERCP procedure uses a modern flexible endoscope system, Endocut's electric knife has the advantage of not causing pancreatitis, pancreatic reaction; The implementation time is fast, safe, there are few complications with the success rate > 98%; A team of reputable doctors with extensive experience In addition to the strict adherence to the principles of sterilization and disinfection to prevent the spread of pathogens through endoscopes for patients and medical staff, exposure to harmful disinfectant chemicals, as well as ensure the patient's privacy, comfort and safety when going to the endoscopy. After the procedure, the patient is closely monitored by a team of professional medical staff, complications can be detected early for timely treatment.

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