SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 50 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission If things are still not going to plan, then a needle-knife can be used to either extend the opening of the ampulla upwards, or (preferably) to find the bile duct from above the opening. A needle knife is essentially a cannula with a tiny needle that protrudes variably from the end. Just enough of the needle has to be visible - too little and the cut is not deep enough to penetrate the lining of the duodenum covering the bile duct, and too much and the cut may be too deep and penetrate through the duodenal wall altogether causing a perforation or bleeding. On the COOK equipment I use, the wire is inserted into the needle knife towards the end and locked in place with a plastic lock. The needle knife is then primed with contrast. To operate the needle knife load it up with the wire and hand the end to the operator, making sure the guidewire is not pulled out of the end. When the tip is visible on the screen the operator will ask you to extend the needle until an adequate portion is visible. The guide on the handle of the sphincterotome can be tightened in position at this point so the same amount of needle protrudes each time (although in practice that rarely happens). The electrical diathermy terminal is then connected to the handle and connection checked. The operator will now use the needle knife to dissect carefully down on to where they believe the bile duct to be (see photo on left - the ampulla is shown at the bottom of the cut) and either insert the needle knife (with needle retracted) directly into the bile duct, or ask you to unlock the wire, which is then passed, hopefully to be seen crossing the endoscope on the Xray picture, signifying that CBD access has been achieved. The wire may then be locked in place and the needle knife exchanged for a sphincterotome to extend the opening. 2 4 16 Fusion - Sphincterotomes Fusion Used for cannulat Order Number Reference Part Number Catheter Size Fr Cathete Tip Size Fr G31539 FS-PRECUT 7 6 Some products or part numbers may not be available in all markets. Contact your regarding: stock/non-stock status (expect longer lead time if non-stock), pricing a Active cord (page 219) available separately.