cholangiopancreatography

Cholangiopancreatography is the radiologic imaging of the bile ducts and pancreatic ducts. It encompasses noninvasive and invasive techniques used to visualize ductal anatomy, detect stones, strictures, leaks, and other abnormalities, and in some cases to treat ductal disease.

Noninvasive magnetic resonance cholangiopancreatography (MRCP) uses magnetic resonance imaging to depict the ducts without endoscopy or iodinated contrast. It is primarily diagnostic and can identify biliary obstruction, choledocholithiasis, bile duct strictures, and pancreatic duct anomalies.

Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy with fluoroscopy. A side-viewing endoscope is advanced to the duodenum, the major papilla is cannulated, and contrast is injected into the biliary and/or pancreatic ducts to produce radiographs. ERCP is used for diagnostic assessment when therapeutic intervention is anticipated, and it also provides therapeutic capabilities such as stone extraction, stent placement, sphincterotomy, balloon dilation, and drainage of leaks.

Indications include suspected biliary obstruction or stones, cholangitis, pancreatic ductal disease, biliary or pancreatic leaks, and post-surgical anatomy evaluation. Contraindications and risks differ by modality. MRCP is avoided in patients with incompatible implants or severe claustrophobia. ERCP carries risks of pancreatitis, cholangitis, perforation, bleeding, and adverse reactions to sedation; it is typically reserved for cases where therapeutic intervention is planned.

Alternatives include MRCP as a noninvasive diagnostic tool and percutaneous transhepatic cholangiography (PTC), which accesses the biliary tree through the skin. The development of ERCP in the 1960s–1970s and MRCP in the 1990s advanced the ability to diagnose and treat biliary and pancreatic duct diseases with varying invasiveness.