Key Points of EST operation that Lead to Success or Failure

Key Points of EST operation that Lead to Success or Failure

ERCP and EST are minimally invasive operations. The successful rate of the operation highly depends on both the technique of physicians and the nursing carebefore, during and after the operation. EST complication occurrence rate is 2.5%~11.3%. Controlling the complications of EST with proper device choice and nursing are crucial to raise the safety of operation as well.

Bleeding control

The most common complication is bleeding with occurrence rate 2%~9%.

Some details in EST operation are useful to prevent bleeding:

1. Control the cutting length. The cutting length could be within 1CM ~ 3CM. The maximum cutting cannot exceed the oral protuberance. In this situation, the reflux function of oddi- sphincter is preserved.

2. The direction of insertion is11 o’clock direction towards the papilla.

3. Electricity current should be controlled within the range of 25W to 30W. Use mixed current. Small current in multiple times are much safer.

4. If needle sphincterotomy is used, control the protruding length of the needle to 4~5 mm to avoid bleeding and perforation.

When bleeding occur, spray with thrombin powder dissolved in 20ml saline, or make local injection of 1% epinephrine dissolved in 10ml saline, or carry out electric coagulation.

Stone extraction

First extract the stone at the lower part, then extract the stone at the upper part. Use balloon to remove the stone debris or stone in flowing status. Stone with diameter less than 10mm could be retrieved by basket.

Stone larger than 10mm could be clamped into small pieces by stone breaking device and taken out by stone retrieval basket.

ENBD tubing technique

Keep the distal end of guide wire above the biliary stricture. Insert the tube through the guide wire. Retreat the endoscope at the same time. Control the speed and do not retreat it fastly. Hold the endoscope still when it retreats to the oral end. Fix the position of the tube and remove the endoscope. Inject with contrast medium to show the position of the tube.

Whole process nursing

Proficient nursing skills before and after ERCP are very import. In a comparison test of nursing care for ERCP operation effect( Chinese and Foreign Medical Research Vol.15, No.3, January 2017.) on 30 patients with biliary stone, it shows that the group with good nursing care before , during and after operation could decrease significantly the depression rate of the patients. The operation time is shorter with average 40 minutes, while the operation in the group without good whole process nursing takes 55 minutes. The hospital stay time is shorter with average 6.2 days. While the other group takes 8.6 days. The whole process nursing group do not result with any complications, while the other group has 6.67% complications with pancreatitis.