ࡱ> M]LI( / 00DTimes New Roman1v 0( 0DArialNew Roman1v 0( 0" DWingdingsRoman1v 0( 00DSymbolgsRoman1v 0( 0 ` .  @n?" dd@  @@`` "+   0@ff3ff@87 uʚ;2Nʚ;g4CdCdv 0"ppp@ <4!d!d` 0L2<4dddd` 0L2? %KADA DA, A KADA NE ERCP Prof.dr.sc.}arko Babi KB Dubrava, Zagreb Klinika za unutarnje bolesti Zavod za gastroenterologiju Odjel za gastroenterologiju&w Indications _Evaluation of chronic pancreatitis Recurrent cholangitis Evaluation of possible cancer of the biliary tree and/or pancreas Choledocholithiasis (ductal stones) Removal of retained bile or pancreatic stones Pre- or post-operative cholecystectomy when ductal stones are suspected Chronic or acute abdominal pain when bile duct disease is suspected 0`^iiip  #0 Indications Suspected primary sclerosing cholangitis (PSC) Evaluation of abnormal biliary system findings from a CT, EUS or MRCP Obstructive jaundice Dilated CBD (common bile duct) Tissue sampling *iii(5   Indications Biliary strictures Sphincter of Oddi dysfunction Palliative or pre-operative stenting of malignant biliary or pancreatic strictures Treatment of bile leaks (biliary ducts or pancratic duct) Pancreatic fluid colections (pseudocysts and necrosis-that communicate with pancreatic duct)"Z8D E       Indications-conclusion4  4TODAY: Therapeutic ERCP Always is indicated in: -Conditions that need immidiate attention and resolution (diagnostic, therapeutic-papilotomy, dilatation, drainage, stenting etc.) -Bile duct (pancreatic duct) dilatation with laboratory signs of cholestasis (bilirubin, GGT, ALP)r0f3Mfffx 8     1   ContraindicationsMAJOR: The risk of sedation GENERAL: Recent myocardial infarction Visceral perforation Recent barium enema-superposition Who cannot cooperate RELATIVE: 1) Patient s needs vrs. Patient s current condition (eg.: may be unstabile due to an infection that is resolved with procedure-biliary sepsis) 2) Coagulopathy (correction !)TFZ i ff* E# #     ` f3f3` ff̙` ___` ff` 3ff3f>?" dd@,?lPd@   Z l<@ d`"  n?" dd@   @@``@n?" dd@  @@``PR    @ ` ` p>>  (  ^N y   "yZ  S B7 C DEHFPv @?q 6 6 n(dx  G b q %(@"B y2   `G1?"  T@tgֳgֳ ?"P  X Click to edit Master title style!!  Txgֳgֳ ?"``  R*   Twgֳgֳ ?"`   T*    Tgֳgֳ ?"`   T* (   0 "  RClick to edit Master text styles Second level Third level Fourth level Fifth level!    S`  Hd޽h? ? f3f3 Soaring=     A(   N t   "tZ   S BsC5 DEHFPv @?3 r4 rv$[I_l3HxF 3 %(@" "2   C CRENGCJRQ1? `TO`TR`TO`TRR`TRR"t  T`gֳgֳ ?"/O  X Click to edit Master title style!!  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