SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 55 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission catheter with balloon deflated above the stone, and injecting contrast to flush the stone out. Sometimes I will inflate the balloon below the stone and pull sharply on the catheter and ask for the balloon to be deflated sharply at the same time - this may act as a sort of suction effect. Tipping the patient head up, feet down to about 15-20 degrees (or just before the point you think they’ll slide off the foot of the bed) may also help the stones to roll down to where they can be reached. Extraction baskets are occasionally used to remove stones. The so called ‘flower baskets’ are useful to try and catch small stones in very wide ducts, but by and large I avoid using them, unless I am very confident the stone will fit through the opening. The fear is always that if a stone is too large to fit through the sphincterotomy then there is a risk the basket may be snagged inside the bile duct. Baskets are really good for snaring stents that have migrated into the bile ducts, though, and I’ll often use them for that. Lithoptripsy is the technique used to use a specialised basket to crush large stones. It seems to cause fear and confusion in assistants everywhere! Certainly the equipment can be a bit daunting, but it’s quite logical if taken step by step: Essentially the lithotripter basket is the same as a normal basket but has a stiff metal sheath which slides over the basket wires when the stone is trapped. This is then attached to the handle on the lithotripter and the ratchet is engaged so it doesn’t slide back again. When the handle is turned the basket wires holding the stone are pulled back towards this sheath until the stone is crushed into pieces small enough to be removed with a balloon. The basket itself is difficult to deploy around a large stone, and the sheath is stiff and unwieldy so this is no-one’s favourite procedure. It rarely works first time as it is usually necessary to carry out a balloon sphincteroplasty first, and because of the time taken to crush the stone and pull the fragments out oedema usually sets in and the opening of the duct shrinks.. COOK make a basket that has a handle that can be fitted into a crank to crush the stone, which is simpler to use, although the basket is quite small. It is usually necessary to undergo more than one ERCP to remove large stones. Thankfully new technology is available in the shape of cholangioscopy (SpyGlass) and EHL to shatter and remove these stones in one go 2 9 68 Biliary/Pancreatic - Extraction Fusion® Extra Used for endos Order Number Reference Part Number Basket Diameter cm Basket Length cm G31905 FS-XB-2X4 2 4 Someproductsorpartnumbersmaynotbeavailable inallmarkets.Contactyour localCook regarding:stock/non-stockst tus (expect longer lead time if on-stock),pricingand/oravail Not tobeusedwithmechanical lithotriptor. Fusion - Extraction Fusion® Lithotripsy Extraction Basket Used for endoscopic removal of biliary stones and foreign bodies.