Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١١٥
Sphincter of Oddi manometry: The gold standard for diagnosing of
sphincter of Oddi dysfunction (SOD) is by sphincter of Oddi manometry
(SOM) performed during ERCP. Intravenous midazolam and meperidine
do not alter sphincter pressure and both may be given for conscious
sedation prior to ERCP with SOM. All drugs that relax (e.g.
anticholinergics, nitrates, calcium channel blockers, glucagons) or
stimulate (e.g. certain narcotics, cholinergic agents) should be avoided for
at least 8 to 12 hours prior to SOM (Waye, 2000). Sphincter of Oddi
manometry is associated with a markedly increased rate of pancreatitis
and should be performed by experienced operators in well-selected
patients (Kim et al., 2004).
Endoscopic Sphincterotomy (ES):
Sphincterotomy is done by the incision of the papilla and sphincter
muscles to open the terminal portion of the CBD. The procedure is
performed with a sphincterotome, which consists of a Teflon catheter
with a cautery wire exposed for a length of 20 to 30 mm near the tip. The
basic technique of sphincterotomy has changed little since its initial
description in 1974 (Classen and Demling, 1974). After deep bile duct
cannulation, the sphincterotome is retracted until one half to two thirds of
the wire length is exposed outside of the papilla. (figure 20).
The sphincterotome-cutting wire is “bowed” until it comes in
contact with the roof of the papilla. Applying intermittent bursts of
diathermic current makes the incision. The length of the incision may
range from 0.5 to 1.5 cm, depending on the size of the stone to be
extracted and the local anatomy. The length of the intraduodenal portion
of the CBD will limit the maximum extent of the cut (Coppola et al.,
1997). Endoscopic sphincterotomy is contraindicated in the presence of