SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 32 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission to contract, squeezing a squirt of bile (and pancreatic juices) into the gut to digest the food. This is why patients have to be starved before an ultrasound scan - to ensure the gall bladder is as large as possible so it and its contents can be seen more easily. Only the ampulla can be seen from the duodenum, and so contrast (a see-through liquid containing iodine, which shows up on X-rays) is injected into the bile ducts through the ampulla and Xray pictures are taken to outline the structures (this is the ‘cholangiogram’) and see if there are any abnormal features (so-called ‘filling defects’) affecting the shape of the normal anatomy. It is important therefore to know what a normal biliary system looks like. As mentioned the pancreas is a fragile gland, with toxic chemicals inside it. We therefore try to avoid putting anything inside the pancreatic duct to avoid causing damage and therefore inflammation to the pancreas (pancreatitis), of which more later. When an Xray is carried out, all that can be seen are the endoscope, the bones, the contrast injected, and any other instruments. Occasionally looking at the gas outlines inside the bowel can be useful. You will note that the bile ducts (CBD) pass behind the endoscope, and the pancreatic duct (PD) passes over the vertebrae. 6 CBD PD