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endoscopic retrograde cholangiopancreatography (ERCP)

Indications: 1) evaluation of: a) *gallbladder disease - gallstones b) *biliary disease - cholangitis - biliary obstruction - bilary cancer - biliary injury - *abdominal trauma or abdominal surgery c) *pancreatic disease - pancreatitis - pancreatic cyst, pancreatic pseudocyst - pancreatic cancer d) *liver disease Preparation: 1) NPO after midnight prior to the procedure 2) allergies to iodine necessitate special considerations (see contrast agent) 3) administer rectal indomethacin 100 mg at the time of the procedure to prevent post-procedure pancreatitis Procedure: 1) ERCP combines the use of X rays & an endoscope 2) visualization of the stomach & duodenum 3) injection of dye into the ducts in the biliary tree & pancreas so they can be visualized on X rays 4) use of a guidewire for cannulation of the bile duct during ERCP may diminish post-ERCP pancreatitis [1] 5) patient lies on left side on an examining table in an X ray room 6) numb back of throat 7) sedation during the exam - propofol or general anesthesia [3] 8) turned on your stomach for pass a small plastic tube through the scope for injection of dye 9) X rays are taken as soon as the dye is injected 10) if the exam shows a gallstone or narrowing of the ducts, instruments can be inserted through the scope to correct the disorder 11) tissue samples (biopsy) can be taken for further testing 12) insert pancreatic stent if patient at risk for post-ERCP pancreatitis 13) ERCP takes 30 minutes to 2 hours Complications: 1) pancreatitis (common) 2) septicemia due to carbapenem-resistant Enterobacteriaceae - design of the duodenoscop may impede effective cleaning [2] 3) bleeding 4) perforation of the duodenum 5) cardiopulmonary complications 6) mortality

Related

magnetic resonance cholangiopancreatography (MRCP) percutaneous transhepatic cholangiography

Specific

biliary endoscopy endoscopic retrograde cholangiography endoscopic retrograde pancreatography pancreatic endoscopy

General

pancreatography cholangiography

References

  1. Cheung J et al. Guidewire versus conventional contrast cannulation of the common bile duct for the prevention of post-ERCP pancreatitis: A systematic review and meta-analysis. Gastrointest Endosc 2009 Dec; 70:1211. PMID: 19962504
  2. FDA MedWatch. Feb 19, 2015 Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes: FDA Safety Communication - Design May Impede Effective Cleaning. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm434922.htm
  3. Williams E et al. Updated guideline on the management of common bile duct stones (CBDS). Gut 2017 Jan 25; PMID: 28122906 http://gut.bmj.com/content/early/2017/01/25/gutjnl-2016-312317
  4. NIDDK: Endoscopic Retrograde Cholangiopancreatography (ERCP) https://www.niddk.nih.gov/health-information/diagnostic-tests/endoscopic-retrograde-cholangiopancreatography