It is a combined endoscopic and radiologic procedure for accessing the bile duct and the pancreatic duct. Earlier used as a diagnostic tool, now it is used mainly for therapeutic indications.
Biliary system and pancreatic duct is visualized by direct cannulation of papilla of Vater and retrograde contrast injection using a side viewing duodenoscope.
This is a highly specialized procedure and should be done by a well trained gastroenterologist as severe complications can occur in untrained hands.
-Bile duct stones
-Biliary fistula or leak
-Malignant biliary obstruction
-Benign biliary stricture
-Pancreatic ductal calculi/stricture (Chronic pancreatitis)
-Transpapillary pancreatic pseudocyst drainage
It is used for diagnosing mucosal pathologies of the esophagus, stomach and duodenum using videoscopes.
Various therapeutic procedures are also carried out viz.
-Endoscopic variceal ligation
-Clip application for ulcer related bleed
It is used for diagnosing mucosal pathologies of the colon and terminal ileum using video colonoscopes.
-Melena (after normal UGIE)
-Stool for occult blood positive
-Suspected colonic neoplasm
-Inflammatory bowel disease
-Foreign body removal
-Treatment of bleeding lesions
Benign esophageal stricture can be peptic, post corrosive injury, post radiotherapy, pill induced, eosinophilic esophagitis, crohn?s disease, anastomotic etc.
Malignant stricture is due to esophageal carcinoma or carcinoma at GE junction.
Dilatation is required when the patient develops dysphagia. Dilatation is done using bougies (Savary Gilliard dilator) or balloons (CRE)
A nasojejunal tube is placed for enteral feeding when gastric emptying is impaired because of mechanical obstruction or impaired gastric motility.
A very common problem in children. Foreign bodies commonly ingested include marble, coin, battery, pins etc. These are removed using accessories such as dormia basket, rat tooth forceps, retrieval net etc.
Achalasia cardia is characterized by increased lower esophageal sphincter tone and aperistalsis. Pneumatic dilatation is considered the first line of treatment in appropriate patient. It consists of tearing the circular muscle fibres of lower esophageal sphincter using a pneumatic balloon.