SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 58 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission Please look carefully at the picture of the cytology brush. Ignore the green guide wire. You will see that the brush itself (A) is set back a bit along the wire (B) which protrudes first out of the plastic sheath (C). To take brushings, the plastic sheath (with the brush inside it) is passed through the stricture to the bile duct beyond it. This can be seen on the Xray image. The brush is then fully extended out of the sheath and the sheath is pulled back so that the brush is in the middle of the stricture. The operator will ask you to move the brush back and forth 10-20 times so that some cells are scraped off the walls of the stricture. It is really important that the first bit of the wire (B) is not pulled back into the sheath as the brush is dragged back and forth, as it may bend inside the stricture as it leaves the opening of the sheath and prevent the brush itself from moving freely, and thus reduce the usefulness of the test. As a general rule, I stop brushing when I can see a bit of blood coming up the brushing catheter - I know then that some cells from the stricture must have been scraped off. In our hospital the entire brush is sent off as quickly as possible to the laboratory where skilled technicians can ensure that the precious cells are preserved. If we are too late in the day, then Cytolyt fluid can be used to preserve the brush tip which is snipped off and kept till the lab reopens. Dilatation of strictures is sometimes necessary if they are very tough to get through, or if a number of stents are required to be placed for drainage. Occasionally biliary and pancreatic strictures are dilated as a primary procedure, but it is unusual these days not to leave a stent in place afterwards to prevent the stricture from closing up again. The dilatation is usually does with a biliary dilatation balloon shown here. They are the same as all dilatation balloons except much smaller. A mixture of contrast and water (approx 30:70) is used to fill them. A Sohendra dilator is a tapered plastic catheter that can be pushed through a stricture to dilate it gradually and has been in use for some years, although I find the balloons to be easier and am more familiar with them. 3 2 A C B