Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١٠٨
Patient preparation includes an updated history and physical
examination, Recent laboratory studies in the form of complete blood
count, liver function test, serum amylase and/or lipase and coagulation
studies.), non invasive imaging of the upper abdomen with abdominal
ultrasound or Computed Tomography (CT) scan, non steroidal anti-
inflammatory drugs should be avoided for 7 days prior to the
procedures,Informed consent for ERCP must be obtained and Patient
should be fasting for 8-12 hours before procedures (Sherman and
Lehman, 1999 and Ways, 2000).
Coagulopathy should be corrected if sphincterotomy is
anticipated.Antibiotic prophylaxis is indicated in the setting of suspected
biliary obstruction, known pancreatic pseudocyst, or ductal leaks (Hirota
et al., 2003).
Patients with known or suspected allergy to iodinated contrast agents
(e.g. given for computed tomography or urograms) should receive steroid
prophylaxis prior to the procedure, and non iodinated contrast should be
used for imaging (Draganov et al., 2000).
(ii) ERCP technique:
Position of the patient:
The standard patient's position for ERCP is prone (chest and
abdomen facing the table), with the left hand behind the patient's back.
This position offers the best access for anterior-posterior fluoroscopy and
X-ray imaging. This position can be modified for patients who cannot
tolerate being prone (e.g. pregnant women, and those with painful limbs
or recent surgical incisions): A semi-prone or lateral position may have to
be accepted in these circumstances. Obese patients are vulnerable to sleep