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Concept
Endoscopic retrograde cholangiopancreatography
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. It is primarily performed by highly skilled and specialty trained gastroenterologists. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject a contrast medium into the ducts in the biliary tree and pancreas so they can be seen on radiographs.
ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.
ERCP can be performed for diagnostic and therapeutic reasons, although the development of safer and relatively non-invasive investigations such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound has meant that ERCP is now rarely performed without therapeutic intent.
The following represent indications for ERCP, particularly if or when less invasive options are not adequate or definitive:
Obstructive jaundice – This may be due to several causes
Gallstones with dilated bile ducts on ultrasonography
Indeterminate biliary strictures and suspected bile duct tumors
Suspected injury to bile ducts either as a result of trauma or of iatrogenic origin
Sphincter of Oddi dysfunction
Chronic pancreatitis is currently a controversial indication due to widespread availability of safer diagnostic modalities including endoscopic ultrasound, CT, and MRI/MRCP
Pancreatic tumors no longer represent a valid diagnostic indication for ERCP unless they cause bile duct obstruction and jaundice. Endoscopic ultrasound represents a safer and more accurate diagnostic alternative
ERCP may be indicated in the above diagnostic scenarios when any of the following are needed:
Endoscopic sphincterotomy of the sphincter of Oddi
Extraction of gallstones or other biliary debris
Insertion of a stent through the major duodenal papilla and ampulla of Vater into the common bile duct and/or the pancreatic duct
Dilation of strictures (e.
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