ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure that combines endoscopy with fluoroscopic imaging to evaluate and treat disorders of the biliary and pancreatic ductal systems. It is used when noninvasive imaging does not provide a definitive diagnosis or when intervention is needed.

During ERCP, a side-viewing endoscope is introduced through the mouth and advanced to the second portion of the duodenum. The major papilla is identified, and a catheter or cannula is guided into the bile duct or pancreatic duct. Contrast dye is injected and X-ray images are taken to visualize the ducts. Therapeutic maneuvers may accompany the diagnostic step, including sphincterotomy (cutting the sphincter), stone extraction, balloon dilation of strictures, placement of biliary or pancreatic stents, and drainage of fluid collections such as pancreatic pseudocysts.

Indications include obstructive jaundice, suspected or confirmed biliary or pancreatic duct stones, cholangitis, biliary or pancreatic duct strictures, leaks, and certain tumors. ERCP is both diagnostic and therapeutic, with options to relieve obstruction, remove stones, or place stents.

Preparation typically involves fasting, assessment of coagulation status, and consideration of antibiotic prophylaxis in selected cases. Sedation or anesthesia is used, and patients are monitored for complications during and after the procedure.

Risks include post-ERCP pancreatitis, infections such as cholangitis, bleeding, perforation, and adverse reactions to sedation or contrast. The overall risk of pancreatitis is a key concern, and prophylactic measures (such as rectal NSAIDs and selective pancreatic duct stenting) can reduce this risk. Alternatives include noninvasive imaging (MRCP) or endoscopic ultrasound (EUS) for certain indications, with ERCP remaining valuable for therapeutic intervention. History traces ERCP to developments in the 1960s and 1970s combining endoscopy with radiographic techniques.