Endoscopic retrograde cholangiopancreatography
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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.
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).
- biliary drainage 2
- bile duct stones removal (e.g. choledocholithiasis) 4
- biliary stenting for strictures and leakage
- biliary or pancreatic ductal system tissue sampling
- triple tissue sampling (TTS) is a common practice 3
- manometry for sphincter of Oddi
- balloon dilation of the duodenal papilla or ductal strictures
- sphincterotomy (e.g. sphincter of Oddi dysfunction or stenosis)
- pancreatitis (~5%) 1
- hemorrhage (2%)
- severe bleeding in 0.1 to 0.5% of cases 1
- perforation leading to pneumoperitoneum and/or pneumoretroperitoneum (<1%) 1
- infection (e.g. cholangitis) 1
- migration of a biliary or pancreatic duct stent
- complications secondary to endoscopy e.g. esophageal and gastric injury
- 1. Szary N & Al-Kawas F. Complications of Endoscopic Retrograde Cholangiopancreatography: How to Avoid and Manage Them. Gastroenterol Hepatol (N Y). 2013;9(8):496-504. PMC3980992 - Pubmed
- 2. Sugawara S, Sone M, Morita S et al. Radiologic Assessment for Endoscopic US-Guided Biliary Drainage. Radiographics. 2020;40(3):667-83. doi:10.1148/rg.2020190158 - Pubmed
- 3. Jailwala J, Fogel E, Sherman S et al. Triple-Tissue Sampling at ERCP in Malignant Biliary Obstruction. Gastrointest Endosc. 2000;51(4 Pt 1):383-90. doi:10.1016/s0016-5107(00)70435-4 - Pubmed
- 4. Frances Aitchison. A Guide to Radiological Procedures. (2009) ISBN: 9780702029820 - Google Books