Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is an examination which combines upper endoscopy and fluoroscopy to visualise and treat pathology of the biliary tree and pancreatic ducts. It only rarely causes complications, but potential complications are severe, so ERCP is mostly used for treatment of pathology rather than for diagnosis, as MRCP is usually sufficient for diagnosis.

ERCP allows for removal of any obstructing pathology, dilating and stenting strictures, and opening the sphincter of Oddi.

Indications

• Most causes of cholestasis, for example:
  • Choledocholithiasis
  • Biliary stricture
• Sphincter of Oddi dysfunction

Procedure

An endoscope is passed through the mouth to the descending duodenum and into the ampulla of Vater. Contrast material is injected, allowing for detailed visualisation of the biliary tract with fluoroscopy. The endoscope has tools which can be used to remove pathology, take samples, dilate, and stent.

Complications

Following ERCP, pneumobilia (air in the biliary tract) is common but rarely problematic. Acute pancreatitis is a potentially severe complication which can be life-threatening, which occurs due to increased pressure in the pancreatic duct from the procedure. Other complications include:

• Perforation of the biliary tract
• Haemorrhage of the biliary tract
• Cholangitis

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