ERCP in Children, Pregnant Patients, and the Elderly
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Although most commonly performed in adults for a variety of reasons, ERCP is also frequently required in special patient subsets. The three most common special patient subsets are children, pregnant patients, and elderly patients (often defined as patients over 60 or 65 years of age). ERCP tools, techniques, and procedures can be different in these patients given their special needs. This chapter will review the role of ERCP in these special patient subgroups.
KeywordsAge considerations Pregnancy and fetal outcome Technical considerations Safety in ERCP Sedation
This clip shows the removal of multiple large stones with balloon extraction following endoscopic sphincterotomy and balloon dilation of the sphincter of Oddi (MP4 13528 kb).
Double wire method to access the CBD in a case of difficult cannulation. The firstl wire kept going into the PD so is left in place and a second wire aids in both selecting the access of the CBD and blocking re-entry into the PD (MP4 11457 kb).
Here the ampulla os is inside a diverticulum and difficult to cannulate with a standard 0.035 wire. A loop tip wire enables entry into the CBD and an endoscopic sphincterotomy and plastic stent placement are then performed (MP4 11523 kb).
A precut sphincterotomy is performed here with small upward cuts from the os along the axis of the CBD following frequent attempts to advance the wire. Once access is gained, dye is injected to confirm entry into the CBD and then an ES is completed (MP4 13393 kb).
In this video clip, an endoscopic sphincterotomy is performed over a wire and then the spyglass cholangioscope is advanced into the biliary tree. Some blood is seen over an ulcerated mass. Towards the end of the video, a forceps is introduced to biopsy this area (MP4 16757 kb).
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