From the Guidelines
ERCP is indicated for therapeutic purposes, particularly in the management of CBD stones, malignant biliary obstruction, and stent placement.
Indications for ERCP
- Management of CBD stones, which can be cleared in 80% to 95% of cases with a balloon sweep of the CBD 1
- Malignant biliary obstruction, where ERCP can be used for stent placement to relieve obstruction 1
- Stent placement in cases of obstructive jaundice, with a success rate of more than 90% for distal CBD strictures 1
- Diagnostic purposes, such as ERCP-guided FNA of biopsies of solid pancreatic neoplasms, with a sensitivity of 57.1% to 82.4% 1
Important Considerations
- ERCP is an invasive procedure with a risk of major complications, including pancreatitis, cholangitis, hemorrhage, and perforation, with a mortality risk of 0.4% 1
- ERCP should be performed with caution in patients with suspected sclerosing cholangitis or biliary stricture, as suppurative cholangitis may be induced by endoscopic catheter manipulation of an obstructed biliary system 1
- MRCP findings may guide directed approaches, such as ERCP, with brushing, percutaneous transhepatic biliary stenting, or reconstructive surgery 1
From the Research
Indications for Endoscopic Retrograde Cholangiopancreatography (ERCP)
- ERCP is indicated for the management of pancreaticobiliary conditions, including severe acute cholangitis, acute biliary pancreatitis with cholangitis, biliary or pancreatic leaks, and severe acute cholecystitis in patients who are unfit for surgery and do not respond to conservative management 2
- Early ERCP is indicated in patients with severe acute biliary pancreatitis with ongoing biliary obstruction but without cholangitis 2
- ERCP is useful in the evaluation and management of acute pancreatitis, including specific causes such as microlithiasis and gallstone disease, pancreas divisum, Sphincter of Oddi dysfunction, tumors of the pancreaticobiliary tract, pancreatic pseudocysts, and pancreatic duct injury 3
- Therapeutic procedures, such as biliary and pancreatic sphincterotomy, stenting, stricture dilation, treatment of duct leaks, drainage of fluid collections, and stone extraction, are common indications for ERCP 4, 3
Timing of ERCP
- Urgent ERCP (<24 h) is indicated for severe acute cholangitis, acute biliary pancreatitis with cholangitis, biliary or pancreatic leaks, and severe acute cholecystitis in patients who are unfit for surgery and do not respond to conservative management 2
- Early ERCP (<48-72 h) is indicated for severe acute biliary pancreatitis with ongoing biliary obstruction but without cholangitis 2
General Principles of ERCP
- ERCP has both diagnostic and therapeutic utilities in managing pancreaticobiliary conditions, although its diagnostic role has been largely replaced by high-quality imaging modalities 5, 4
- ERCP is a complex and technically demanding procedure with a risk of adverse events, including post-ERCP pancreatitis, bleeding, perforation, infection, and cardiopulmonary or sedation-related events 5, 6