Endoscopic retrograde cholangio-pancreatography (ERCP)

Summary

Definitions

Endoscopic retrograde cholangio-pancreatography (ERCP) is the passage of an endoscope to the second part of the duodenum allowing access to the major papilla, and the subsequent cannulation of the biliary and/or pancreatic ductal systems. These are opacified by injection of contrast media permitting their visualization and allowing for a variety of therapeutic interventions.

ERCP is a complex endoscopic procedure with a similar level of risk to some major operations; consequently it needs to be carefully planned. Since the advent of more advanced non-invasive imaging, i.e. magnetic resonance cholangio-pancreatography (MRCP) and endoscopic ultrasound, the majority of ERCPs performed are therapeutic rather than diagnostic. Pancreatic therapy and biliary manometry is usually only performed in specialist centres.

Indications

COMMON

1. ▪ Removal of common bile duct stones prior to or after cholecystectomy.

2. ▪ Diagnosis and stenting of biliary strictures; malignant (pancreatic cancer, cholangiocarcinoma) and benign (inflammatory, postoperative). Brushing the stricture can provide cytological samples.

OTHER

1. ▪ Diagnosis of obstructive jaundice if other imaging inconclusive e.g. to confirm primary sclerosing cholangitis.

2. ▪ Endoscopic therapy of postoperative biliary leaks i.e. by stenting.

3. ▪ Severe gallstone pancreatitis, associated with biliary obstruction (early intervention with ERCP reduces morbidity and mortality).

4. ▪ Investigation and treatment of recurrent acute pancreatitis e.g. by diagnosing and treating pancreatic duct stones and strictures.

5. ▪ Diagnosis of ‘sphincter of Oddi dysfunction’ by biliary manometry.

Procedure

PRE-PROCEDURE CONSIDERATIONS

To keep your endoscopist happy, patients should be sent for ERCP with consent performed, a cannula in the left arm and a recent FBC and clotting screen clearly visible in the notes.