Diagnostic Endoscopic Retrograde Cholangiopancreatography

Abstract

The importance of diagnostic endoscopic retrograde cholangiography (ERCP) has dramatically decreased owing to the development of less invasive techniques such as ultrasonography, computed tomography, endoscopic ultrasonography, and finally magnetic resonance cholangiopancreatography (MRCP). MRCP is becoming the gold standard in the diagnostic work-up of the pancreaticobiliary duct. However, MRCP cannot solve all the problems that occur, and still has inadequate resolution for small stones and tiny pancreatic and bile duct lesions. ERCP continues to be useful in difficult cases and when the diagnosis is uncertain, particularly when fluid collection and tissue sampling are necessary. However, several alternatives to sphincter of Oddi manometry have been proposed. Finally, ERCP is always the first step before endoscopic treatment, which in contrast to diagnostic ERCP is still widely used.

Cross-sectional imaging of biliary tumors: current clinical status and future developments

“…However, for tumors in the region of the papilla of Vater, it allows good visualization of the lesion and biopsy specimens to be taken. Sensitivity for differentiation between benign or malignant biliary strictures is about 90% with a specificity of only 70% [26][27][28]. However, ERC does not allow for complete staging of biliary tumors, since only the tumor extent within the biliary system is displayed, whereas the tumor itself and possible invasion of the vasculature, hepatic parenchyma or other surrounding tissue cannot be assessed.…”

Transgastric endoscopic ultrasonography-guided biliary drainage: results of a pilot study

“…Although endoscopic biliary stenting is the main treatment for biliary obstruction, it can fail in 3 % ± 12 % of cases [9,10], at pres− ent leaving only surgical or percutaneous approaches as alterna− tives. However both have a higher morbidity and mortality, and permanent transhepatic external drainage may be uncomforta− ble for patients receiving palliative treatment.…”

Preoperative endoscopic sphincterotomy in the treatment of patients with cholecystocholedocholithiasis

“…However, some authors have suggested that preoperative ERCP screening for CBD stones is inappropriate, not only because the cost is high but also because, for the majority of procedures, such screening is unnecessary. In addition, complications, such as pancreatitis, cholangitis, and drug side effects, were reported in 2% of patients who underwent ERCP 14…”