Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١١٠
years of age, the developmentally delayed, uncooperative patients (eg,
confused, demented, alcoholic), patients with a history of intolerance to
conscious sedation and those at risk for ventilator or the morbidly obese
(Koshy et al., 2000).
Many patients with suspected type III sphincter of Oddi dysfunction
(SOD) require GA, as they are typically chronic users of narcotic
analgesia and benzodiazepine (Wehrmann et al., 1999).
Introduction of the endoscope:
The side viewing endoscope is introduced into the hypopharynx; the
tip is advanced blindly to the cricopharyngeous, causing the patient to
swallow. The duodenoscope is furtherly introduced into the esophagus,
the stomach and the duodenum (Waye, 2000).
Then a brief endoscopic examination of these segments was done.
The finding of a large ulcer or neoplasm may cancel the need for ERCP.
Other findings such as varices, a pseudocyst pressing on the gut wall, or
oedema of the medial wall of the duodenum help to quantitate or localize
disease processes (Sherman and Lehman, 1999).
Carbon dioxide insufflation during ERCP significantly reduces
postprocedural abdominal pain. No side effects were observed. Carbon
dioxide should be the standard gas used for insufflation in ERCP
(Bretthauer et al., 2007).
Approaching the papilla:
No cannulation of the papilla is attempted until the papilla is seen
squarely and up close. Once it is found and the tip of the endoscope is
perfectly aligned with the pyloric channel, the tip of the endoscope must
be deflected up into the descending duodenum. Then straightening of the
endoscope is done to get straight scope position which is done by 90-180