SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 56 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission Emergency Lithotripsy is the procedure carried out when the stone has indeed got stuck in the duct and the basket cannot be removed. The handle of the basket has to be cut off with wire cutters and the endoscope removed leaving wires protruding from the patients mouth. A metal sleeve is then slid down over the wires and the cut end of the wires is attached to a crank as shown in the picture. This is then turned until the sleeve breaks off the wires holding the stone, or the stone is crushed. The ERCP then is resumed and the pieces of stone are removed or, more likely a pigtail stent is left in place to continue the procedure another day. If stones are left in the CBD, this does not constitute a failure. Generally speaking, the longer a procedure goes on, the more likely the patient is to suffer discomfort or complications, and the less likely the procedure is going to be successful. Knowing when to stop is a vital skill in ERCP operators . A double pigtail stent is placed into the CBD to keep the stones from occluding the duct - imagine a funnel with a golf ball in it, and imagine placing a pencil through the opening of the funnel to prevent the ball from blocking flow through it. 3 0 77 Biliary/Pancreatic - Extracti n Cook Medical Soehendra® Lithotriptor Used to mechanically crush stones in the bile duct when other methods of endoscopic removal have failed. This device is supplied non-sterile and is reusable if the device int grity i intact. Order Number Reference Part Number Cable Size Fr Cable Length cm Description G21860 SLH-1 n/a n/a aluminum lithotripsy handle G21604 SLC-2 14 82 lithotripsy cable Some products or part numbers may not be available in all markets. Contact your local Cook representative or Customer Service for details regarding: stock/non-stock status (expect longer lead time if non-stock), pricing and/or availability. Compatible with Memory Basket 7 Fr Soft Wire (page 70), The Web Extraction Baskets (page 69) and Fusion Lithotripsy Extraction Basket (page 67), sold separately. SLH-1 compatible with Conquest TTC (page 76). SLC-2 not compatible with Fusion Lithotripsy Extraction Basket.