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Endoscopic retrograde cholangiopancreatography (ERCP)

General

Endoscopic retrograde cholangiopancreatography (ERCP) provides an X-ray image of the bile ducts and pancreatic ductal system by direct injection of contrast into the ductal system.

The technique also provides access to both extended diagnostics and therapeutic procedures for the bile ducts and pancreas.

The procedure can be performed on an outpatient basis and is similar to gastroscopy. If a therapeutic procedure is performed, the patient often stays in the hospital for observation. 

For ERCP, a duodenoscope is used which is a special gastroscope with side viewing optic. This makes it significantly more suitable to manipulate the duodenal papilla, however navigation is more difficult. Various customized instruments can be passed through the instrument canal of the endoscope and further on through the papilla.

Indications

Cancer in the pancreas or liver/bile ducts:

  • Diagnostic technique for ambiguous cases (visualization of ductal system and possible brush sampling or biopsy)
  • Preoperative bile/pancreatic duct decompression 
  • Symptom relieving drainage of bile/pancreatic ductal system  in cases of inoperable cancer
  • Local removal of early stage cancer in duodenal papilla 

A common feature is that all of these indications include therapy. Diagnostic ERCP is applied to a diminishing degree, but may still be used for collecting tissue samples (cytology or biopsy).

Goals

  • Obtain a diagnosis
  • Drain stenotic ductal systems

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