Endoscopic retrograde cholangiopancreatography (ERCP)


A technique that combines the use of endoscopy and fluoroscopy to diagnose and treat and problems of the biliary or pancreatic ductal systems.



In ERCP, the endoscope enters through the mouth and passes through the stomach and start of the small intestine to reach the bile ducts.

The primary method for the pancreatobiliary system access.

Through the endoscope injection of dye into the ducts in the biliary tree and pancreas so they can be visualized.

ERCP, short for endoscopic retrograde cholangiopancreatography, is an endoscopic procedure that can remove gallstones or prevent blockages by widening parts of the bile duct where gallstones frequently get stuck. 

Used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures and , leaks, and cancer.

ERCP is often used to retrieve stones stuck in the common bile duct in patients with gallstone pancreatitis or cholangitis. 

ERCP can be performed for diagnostic and therapeutic reasons.

Following sedation a flexible endoscope is inserted through the mouth, down the esophagus, into the stomach, through the pylorus into the duodenum to the ampulla of Vater and a plastic catheter or cannula is inserted through the ampulla, and radiocontrast is injected into the bile ducts, and/or, pancreatic duct.

Fluoroscopy is utilized to look for blockages, stones or other lesions.

Radiopaque dye administered through the endoscope into the bile duct allows vizualizatiin of stones or other blockages on x-ray.

The opening of the ampulla can be enlarged with the catheter and access into the bile duct obtained so that gallstones may be removed or other therapy performed.

By ERCP common bile duct stones can be removed and bile drainage can be achieve, the pancreatic duct can be cannulated, visualized and stents can be inserted.

The pancreatic duct requires visualization in cases of pancreatitis.

The gallbladder should be surgically removed following successful removal of gallstones from the bile ducts.

Risk of pancreatitis can occur in up to 5%-15% of all procedures following ERCP.

Acute pancreatitis is most common major complication of ERCP.

Post-ERCP pancreatitis has the potential for substantial morbidity and mortality.

Mechanisms of pancreatic injury during ERCP include: mechanical, thermal, chemical, hydrostatic, enzymatic, and microbiological insults.

Prolonged manipulation of the papillary orifice, and difficult cannulation of the biliary tree plus repeated inadvertent instrumentation of the pancreatic duct may result in the injury injury to the ampulla.

Thermal injury may result from electrocautery current used during sphincterotomy, endoscopic papillectomy, or ablation of neoplastic lesions in the region of the ampulla of Vater.

Temporary pancreatic stents have prophylactic benefit for post-ERCP pancreatitis.

Risk of pancreatitis after ERCP increased in younger patients, patients with previous post-ERCP pancreatitis, females, when the procedure that involves cannulation or injection of the pancreatic duct, and patients with sphincter of Oddi dysfunction.

Rectal indomethacin in patients at high-risk of for post-ERCP pancreatitis significantly reduces the process, 9.2% vs. 16.9% in the placebo group (Elmunzer BJ et al).

Gut perforation and bleeding can ocur particularly with sphincerotomy.

Among principal indications for stent placement is benign bile duct strictures, and ERCP is the preferred first line treatment strategy.

Endoscopic treatment of benign biliary stricture is is less morbid than surgical and percutaneous approaches and has a low recurrence rate when an aggressive treatment strategy is employed.

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