SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 54 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission balloon. In addition the duct may not be the same width along the length of it so the diameter of the balloon may need to be adjusted as the balloon is trawled down the duct. Just as when you blow up a party balloon, there is an initial need for extra pressure to get the inflation started, then the balloon springs into shape and may overshoot the size required. If the pressure is released too much then the balloon may shrink back to zero again, so a degree of practice and dexterity is required. Of course this is all done as the Xray machine is working so the longer it takes to get the balloon to the correct size, the more radiation the patient (and everyone else to a lesser extent) is exposed to. Inexperienced assistants are often quite tentative when inflating the balloon so my advice would be to give the syringe a good squeeze to start the inflation, but be ready to release some air out of the balloon if it’s too big. And of course - take the time to familiarise yourself and practise with the equipment used . The CBD tends to be widest at the midpoint, and tapers towards the bottom, so the balloon may need to be deflated slightly to allow it to pass through the sphincterotomy. Small deflations can be carried out by turning the tap on the syringe sharply 180 degrees (don’t turn the tap fully to open, and don’t keep your thumb on the syringe plunger when doing this). This allows the tiny amount of air inside the tap itself to be expelled back into the syringe and the balloon will shrink by a millimetre or so. This can be repeated until the balloon has been shrunk to the desired size. It’s a really useful trick which again should be practiced. I’m never sure how to describe this manoeuvre - I usually ask for the balloon to be deflated ‘a bit’ which is pretty hopeless unless you the assistant are familiar with what I mean! Small stones may roll up into the liver where the ducts are smaller and be difficult to see and extract. There are a few tricks that can be employed to get them down into the CBD, which include passing the wire into the duct where the stone is and trying to get the 2 8