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The enduring role of X-ray in endoscopic retrograde cholangiopancreatography (ERCP)
“It’s an exciting time to be in medicine,” reflects Dr. Klaus Welslau with a smile, sitting in his office in Oelde, Germany. And he should know. Dr Welslau wears many hats: as Marienhospital Oelde’s Chief of Medicine, as a clinician specializing in gastroenterology, and as a European Fellow of Gastroenterology. He bases his predictions on 25 years of experience in endoscopic retrograde cholangiopancreatography (ERCP). “ERCP as a clinical area will continue to rely on X-ray for diagnostic insight,” he says. “Sure, endoscopes are getting smaller and smaller, and more ‘intelligent’. Even then, they will only deliver some of the information that X-ray offers now. So the choice of X-ray system still matters.”
Selecting a mobile C-arm system for ERCP
With so many choices in the market, it can be challenging to focus on the right tools at the right time for the right patient and procedure. Is a system with angiography capabilities, for example, necessary to investigate biliary obstruction using ERCP? What’s more, choosing the right system involves multiple stakeholders with multiple needs. Clinicians who need to perform ERCP will understandably emphasize aspects related to image quality, such as visualization of key anatomy. Professionals in purchasing and planning will also consider the system’s location in the hospital and the number of users. For Ludger Strake, a medical technician at Marienhospital Oelde, service was a high priority when selecting a mobile C-arm system for ERCP procedures. His many responsibilities cover equipment procurement and maintenance. “It goes without saying that we carefully reviewed many technical aspects like X-ray performance, PACS connectivity and overall ease of use,” he says. “We liked what we saw with the Philips BV Pulsera C-arm system. But you also have to listen to your gut, as I like to say. Any system you choose is going to be with you for a long time. At some point, you’ll need to rely on service. Which provider do you feel most comfortable with?” For Strake, it was Philips. “Everything came together, the usability, the interoperability, the support, and it just felt ’right’.”
What the Philips C-arm does very, very well is to help us see important structures and outlines, locate stones, define tumors, show the biliary tree – the things gastroenterologists are looking for, even with overweight patients.”
Dr Klaus Welslau, Chief of Medicine and gastroenterologist at Marienhospital Oelde, Oelde, Germany
When we considered the BV Pulsera C-arm system as a whole, including service, we knew we would be in good hands with Philips”
Ludger Strake, medical technician at Marienhospital Oelde, Oelde, Germany
Bringing the BV Pulsera system to your gastroenterology practice
Philips was the first company to market the mobile C-arm and has over half a century of experience in developing systems of this type. Today, the Philips BV Pulsera C-arm is paired with the STILLE imagiQ2™ imaging table to help hospitals deliver clinical excellence and work efficiently when it comes to ERCP procedures. The C-arm and accompanying Mobile View Station offer exceptional contrast and clarity along with multiple features to manage radiation and promote high-quality imaging and dose efficiency. The table also supports high-quality images through increased translucency and freedom of movement.
Seeing what matters, with confidence
The system’s X-ray and endoscopic imaging capabilities visualize key anatomy for Dr Welslau, such as the tiny 1-2 mm opening in the small intestine where clinicians must decide to continue into either the biliary tree or pancreatic duct. Certainty is essential in ERCP. “The X-ray image on the C-arm shows me if the guidewire is going in the right direction,” he says. He freezes that image and uses it as a reference on the screen on the right while the live images are displayed on the left.
Working together to manage dose
“For me, image quality means getting the maximum amount of information from images at the correct dose,” continues Dr Welslau. Comprehensive dose management features on the BV Pulsera, such as unique beam filters and Pulsed Fluoroscopy, allow low X-ray dose for exceptional images. But what about the imaging table? The STILLE imagiQ2™ patent-pending carbon fiber table top offers 60% more translucency as it has transparency of 0.4 mm Al equivalency (average tables have 1.0mm Al equivalency). “This means less scatter radiation for me and the patient,” says Dr Welslau.
Case 1
Patient details: 90-year-old female patient; history of cholecystolithiasis
ERCP context: performed via endosonography and an abdomen CT (due to patient’s lipase condition)
Findings: normal intrahepatic biliary system; patent cystic duct; evidence of cholecystolithiasis
Intubating the papilla was difficult since it was located on the medial margin of a juxtapapillary diverticulum. The papilla was first luxated out of the diverticulum, only then was it possible to intubate the pancreatic duct. The two-guidewire method was used to selectively intubate the biliary tree.
Case 2
Patient details: 74-year-old female patient; presenting with obstructive jaundice, weight loss and epigastralgia
Findings: hepatic metastatic pancreatic head carcinoma, stage T4N1M1
Intervention: stent implanted
A view of the completely obstructed common hepatic duct in the medium/distal third with evident dilatation of the intrahepatic biliary tree. A guidewire had been left in the patient’s body for future diagnostic and therapeutic interventions.
Helping single users work efficiently
A typical ERCP exam calls for both a clinician and an operator in the room. But this setup can pose financial and staffing challenges, especially for smaller hospitals. The BV Pulsera system can help relieve some of that pressure with its single user concept. Dr Welslau sets up and performs exams by himself, freeing up operators for patient care elsewhere. “What I really like about this combination is that once I set the C-arm,” he explains, “the only adjustment I need to make is a minor one to the table.” He particularly values the free-floating table top, which offers freedom of movement in any direction, especially horizontally. “I can do it one-handed, even when I need to shift it just 10 cm and with a 120 kg patient on the table.”
Why choose Philips for ERCP? A cost-effective investment can help you increase patient comfort and streamline care delivery.
A mobile C-arm and imaging table complement one another and may help keep ERCP procedures and their revenue within the hospital.
Comfortable positioning enhances the patient experience during their visit.
A smart combination of functionalities frees up resources and expertise for other procedures, especially for small teams in which clinicians work across disciplines.
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