SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 45 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission The wires used come in different shapes, widths, lengths, degree of slipperiness and tips. There are differences between them, but in my experience, once again the standard COOK Acrobat 2 wires are perfectly adequate for virtually all ERCP procedures and I rarely need to change them, so for this reason I stick with them rather than give myself the doubtful luxury of choice. Different stents are a larger topic which will be dealt with in a separate chapter. The COOK Medical catalogue has 240 pages of various bits of equipment that are all a bit different, and that is only one of a half dozen or so established manufacturers. There are advantages on all sides to keep things simple, and whilst I am open to look at any new bits of equipment produced by anyone, ultimately it is the patient who has to benefit from this, and so the fewer pieces of equipment that both operator and assistants have to familiarise themselves with, the better. How much should the assistant help? Again this is a matter of preference which depends largely on how the operator has been taught and their experience. In the majority of units I have visited I note a heavy dependence on the assistant to push the wire, bow the sphincterotome, inject the contrast and so forth. Perhaps because of ever-changing assistants, frequently needing to teach registrars in ERCP, and a lack of standardisation of commands (eg ‘dye’ or ‘contrast’, ‘push’ or ‘advance’ the wire, ‘bow’ the sphincterotome or ‘bend’ it), for which I accept all blame, or maybe because I feel it is unfair on the assistant to instinctively know how much to advance the wire or bend the sphincterotome (and these things are really fiddly), I have developed a technique which is reliant on me doing all things and the assistant at this point only holding the handle of the sphincterotome in such a way that I can operate it myself. Assistants must become familiar with the preferences of the operators they work with, and similarly operators must not assume this knowledge. Both must communicate their preferences effectively, preferably before the case has started! If you find yourself working with an ERCPist for the first time, please feel free to ask these questions in advance and be aware there are probably as many techniques as there are operators and it is perfectly reasonable to find out in advance what is expected of you. 19