Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١٠٩
apnea, and frequently develop hypoxia under conscious sedation (Jastak
et al., 1991).
Positioning "tricks'for Special Situations: When the intubatation of the
pylorus with the duodenoscope is difficult, roiling the patient 90 degrees
from the prone into the left lateral position is often helpful. Especially
when the patient has a large stomach, or when much of the stomach has
herniated into the chest. Changing the patient's position can also improve
one's chances of intubating the afferent limb after Billroth-I1 gastrectomy
(Wright et al., 2002).
When the pancreatic duct proves difficult to fill completely during
pancreatography, remove the catheter, withdraw the endoscope, and
quickly roll the patient on to his or her back. Provided that some contrast
remains in the duct, the tail will usually fill by gravity with this maneuver
(Tham et al., 2003).
In pregnant women, the fetus should be protected from irradiation by
lead shielding; obviously, this is easiest in the first trimester and hardest
in the last. It should be remembered that in most X-ray tables, the X-rays
are generated from below and are detected above the patient. ERCP in
pregnancy is safe and effective (for appropriate indications) (Jamidar et
al., 1995).
Sedation:
Conscious Sedation versus General Anaesthesia (GA). Most
endoscopic procedures can be accomplished using standard conscious
sedation such as diazepam, but increasingly we are using GA for
prolonged procedures, and when patients prove difficult to sedate
(Raymondos et al., 2002). General anesthesia is normally required for
ERCP in the following patient groups: infants and children under 16