Endoscopic retrograde cholangiopancreatogram

From Ganfyd

An endoscopic retrograde cholangiopancreatogram (ERCP) is an investigation of the biliary tree and pancreatic ducts using endoscopy, radio-opaque contrast and fluoroscopy.

Indications

• Obstructive jaundice
• Symptomatic choledocholithiasis (e.g. pancreatitis)

Contraindications

• Previous stomach surgery that precludes easy passage of the endoscope into the duodenum
• Uncorrected coagulopathy (if intervention considered)

Procedure

ERCP showing a bile duct stone in a patient who has had a previous laparoscopic cholecystectomy.

The initial insertion of the ERCP endoscope is similar to a conventional upper GI endoscopy. The important difference is that the endoscope used in ERCP is side-viewing and has additional channels to facilitate the imaging and intervention.

Once the endoscope is in the second/third part of the duodenum, the papilla of Vater is cannulated. Injection of radio-opaque contrast is observed fluoroscopically, giving images of the outlined pancreatic and biliary ducts.

Brushing may be indicated for cytological diagnosis of carcinoma with sensitivites of 30-75% for adenocarcinoma of pancreas.

ERCP also allows intervention, e.g. sphincterotomy, stone extraction (e.g. with Dormia basket) and biliary stent insertion.

Complications

• Bleeding
• Pancreatitis
• Ascending cholangitis

External Links

• Endoscopic retrograde cholangiopancreatography in gallstone-associated acute pancreatitis, Cochrane Systematic Review (2005)
• A systematic review and economic evaluation of magnetic resonance cholangiopancreatography compared with diagnostic endoscopic retrograde cholangiopancreatography, Health Technology Assessment (2004)