Endoscopic retrograde cholangiopancreatography

Last revised by Andrew Murphy on 26 Mar 2023

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and interventional procedure technique using both endoscopy and fluoroscopy for examination and intervention of the biliary tree and pancreatic ducts. It is typically performed by doctors with endoscopic qualifications (e.g. general surgeons, gastroenterologists) rather than radiologists.

It involves passing an endoscope to the descending duodenum and subsequently cannulating the ampulla of Vater, after which contrast can be injected outlining the biliary tree and various procedures can be performed. 

It is conventional practice to acquire a diagnostic CT intravenous cholangiogram and/or MRCP, followed by a therapeutic ERCP.

Pneumobilia is common post-ERCP and may be present even when the history of the procedure is remote (especially if a sphincterotomy has been performed). 

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