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.

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

Pneumobilia is common post-ERCP including when the history of the procedure is remote (especially if a sphincterotomy has been performed).

Indications

biliary drainage
bile duct stones removal (e.g. choledocholithiasis)
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)

Contraindications

relative
- altered anatomy in post-surgical states (e.g. Billroth II gastrojejunostomy, Roux-en-Y jejunostomy)
- structural abnormalities of oesophagus, stomach or duodenum
- coagulopathy
absolute
- unstable patient

Complications

pancreatitis (~5%)
haemorrhage
perforation leading to pneumoperitoneum and/or pneumoretroperitoneum
infection (e.g. cholangitis)
migration of a biliary or pancreatic duct stent
complications secondary to endoscopy e.g. oesophageal and gastric injury

~~-<a title="triple tissue sampling" href="/articles/triple-tissue-sampling">triple tissue sampling (TTS)</a> is a common practice <sup>3</sup>~~
+<a href="/articles/triple-tissue-sampling">triple tissue sampling (TTS)</a> is a common practice <sup>3</sup>
~~-<li>manometry for <a title="Sphincter of Oddi" href="/articles/sphincter-of-oddi">sphincter of Oddi</a>~~
+<li>manometry for <a href="/articles/sphincter-of-oddi">sphincter of Oddi</a>
~~-<li>sphincterotomy (e.g. <a title="Sphincter of Oddi dysfunction" href="/articles/sphincter-of-oddi-dysfunction">sphincter of Oddi dysfunction</a> or stenosis)</li>~~
+<li>sphincterotomy (e.g. <a href="/articles/sphincter-of-oddi-dysfunction">sphincter of Oddi dysfunction</a> or stenosis)</li>
~~-<li><a title="Coagulopathy" href="/articles/coagulopathy">coagulopathy</a></li>~~
+<li><a href="/articles/coagulopathy">coagulopathy</a></li>
~~-<a title="migration of stent" href="/articles/migration-of-stent">migration</a> of a biliary or pancreatic duct stent</li>~~
+<a href="/articles/migration-of-stent">migration</a> of a biliary or pancreatic duct stent</li>

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