From the Guidelines
ERCP (Endoscopic Retrograde Cholangiopancreatography) is a specialized medical procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions of the bile ducts, gallbladder, and pancreas, with a primary indication for management of CBD stones and a high success rate for stent placement in cases of obstructive jaundice 1.
Overview of ERCP
ERCP is an invasive procedure that is typically performed by gastroenterologists or general surgeons in an interventional suite or operating room under general anesthesia, requiring advancing 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 management of CBD stones, which can be cleared in 80% to 95% of cases with a balloon sweep of the CBD 1. ERCP is also used for therapeutic endoscopic intervention, including sphincterotomy, to remove CBD stones and may be curative when done prior to cholecystectomy 1.
Risks and Complications
As an interventional procedure, ERCP has a risk of between 4% to 5.2% for major complications, including pancreatitis, cholangitis, hemorrhage, and perforation, with a 0.4% mortality risk 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 1. Tissue diagnosis can be obtained by endoscopically directed brushing or guided US with FNA 1.
Comparison with Other Procedures
Magnetic resonance cholangiography (MRC) is now recommended as a first-line non-invasive imaging method for patients with suspected primary sclerosing cholangitis (PSC) that offers comparable accuracy to ERCP 1.
Patient Preparation and Aftercare
Patients typically receive sedation or anesthesia for comfort during the procedure, which usually takes 30-90 minutes 1. After ERCP, patients may experience mild discomfort, bloating, or sore throat, and serious complications are rare but can include pancreatitis, infection, bleeding, or perforation 1.
Key Points
- ERCP is a specialized medical procedure for diagnosing and treating conditions of the bile ducts, gallbladder, and pancreas.
- The primary indication for ERCP is management of CBD stones.
- ERCP has a high success rate for stent placement in cases of obstructive jaundice.
- ERCP carries risks of major complications, including pancreatitis, cholangitis, hemorrhage, and perforation.
- MRC is recommended as a first-line non-invasive imaging method for patients with suspected PSC.
From the Research
Definition and Purpose of ERCP
- Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure used to diagnose and treat conditions of the pancreaticobiliary diseases 2.
- It has evolved from a primarily diagnostic to therapeutic procedure in hepatobiliary and pancreatic disease 3.
- ERCP is used to relieve biliary or pancreatic duct obstruction, and is mainly used as a therapeutic approach 4.
Procedure and Risks
- ERCP is a complex and technically demanding procedure with a high inherent risk of adverse events, including post-ERCP pancreatitis, bleeding, perforation, infection, and cardiopulmonary or sedation-related events 2.
- The overall adverse event rates for ERCP are typically reported as 5-10% 2, 5.
- The most common causes of post-ERCP pain are acute pancreatitis and duodenal perforation 5.
Advances and Improvements
- Improvements in technology and technique have allowed for the management of pancreatic duct stones, benign and malignant strictures, and bile and pancreatic leaks 3.
- The introduction of new disposable duodenoscopes has eliminated transmissible infections and represents a paradigm shift in quality improvement within ERCP 3.
- Endoscopic ultrasound (EUS) has allowed for direct bile duct access and EUS-facilitated bile duct access for ERCP 3.
Outcomes and Results
- The technical success rate of ERCP is high (>90%) 4.
- The post-procedure 30-day mortality rate ranges between 1 and 5% and is strongly correlated with older age, male sex, emergency admission, and non-cancer comorbidities 4.
- ERCP is currently mainly used as a therapeutic approach, and the results are generally likely to improve patients' conditions 4.