From the Guidelines
ERCP stands for Endoscopic Retrograde Cholangiopancreatography, an invasive procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions of the bile ducts, pancreatic ducts, and gallbladder, with a risk of major complications between 4% to 5.2% and a mortality risk of 0.4% 1.
Overview of ERCP
ERCP is typically performed by gastroenterologists or general surgeons in an interventional suite or operating room under general anesthesia, requiring the advancement of an endoscope into the duodenum, with cannulation of the ampulla and injection of contrast into the CBD with fluoroscopic images obtained to image the biliary tree 1.
Indications and Uses
The main indication for ERCP remains the management of CBD stones, which can be cleared in 80% to 95% of cases, and it is also the standard procedure for stent placement in cases of obstructive jaundice, with a success rate of more than 90% for distal CBD strictures 1.
Diagnostic Yield
ERCP has equivalent or greater sensitivity for tumor detection, particularly for ampullary carcinoma, but it does not provide staging information for operability, and tissue diagnosis can be obtained by endoscopically directed brushing or guided US with FNA 1.
Risks and Complications
As an interventional procedure, ERCP has a risk of major complications, including pancreatitis, cholangitis, hemorrhage, and perforation, with a mortality risk, and these factors need to be weighed against the potential benefits of ERCP 1.
Precautions and Considerations
Patients with suspected sclerosing cholangitis or biliary stricture should undergo ERCP with caution, as suppurative cholangitis may be induced by endoscopic catheter manipulation of an obstructed biliary system, and MRCP findings may guide directed approaches, such as ERCP, with brushing, percutaneous transhepatic biliary stenting, or reconstructive surgery 1.
From the Research
Definition and Purpose of ERCP
- ERCP stands for Endoscopic Retrograde Cholangiopancreatography, a procedure used to diagnose and treat problems in the bile and pancreatic ducts 2.
- It was introduced over four decades ago as a diagnostic tool, but is now mainly used as a therapeutic approach to relieve biliary or pancreatic duct obstruction 2.
- ERCP is used to treat conditions such as gallstone pancreatitis, bile duct stones, and other biliary and pancreatic diseases 3, 4.
Procedure and Techniques
- ERCP involves the use of an endoscope to visualize the bile and pancreatic ducts, and various techniques such as endoscopic sphincterotomy to remove stones or other blockages 3, 4.
- The procedure can be used in combination with other imaging modalities such as magnetic resonance cholangiopancreatography (MRCP) to diagnose and treat biliary and pancreatic diseases 4, 5.
- ERCP can be performed therapeutically to relieve obstruction, or diagnostically to visualize the bile and pancreatic ducts and take tissue samples 2, 6.
Indications and Outcomes
- ERCP is indicated for patients with suspected biliary or pancreatic disease, such as gallstone pancreatitis or bile duct stones 3, 4.
- The outcomes of ERCP are generally good, with high technical success rates and low complication rates 2.
- However, the risk of complications such as pancreatitis, cholecystitis, and cholangitis is higher in certain patient populations, such as those with primary sclerosing cholangitis or liver cirrhosis 2.
- The use of ERCP in combination with other procedures such as cholecystectomy or pancreatic duct stenting can improve outcomes in certain patient populations 3, 6.