Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and interventional procedure technique using both endoscopy and fluoroscopy for examination and intervention of the biliary tree and pancreatic ducts. It is typically performed by doctors with endoscopic qualifications (e.g. general surgeons, gastroenterologists) rather than radiologists.

It involves passing an endoscope to the descending duodenum and subsequently cannulating the ampulla of Vater, after which contrast can be injected outlining the biliary tree and various procedures can be performed.

It is conventional practice to acquire a diagnostic CT intravenous cholangiogram and/or MRCP, followed by a therapeutic ERCP.

Pneumobilia is common post-ERCP including when the history of the procedure is remote (especially if a sphincterotomy has been performed).

Indications

• biliary drainage
• bile duct stones removal (e.g. choledocholithiasis)
• biliary stenting for strictures and leakage
• biliary or pancreatic ductal system tissue sampling
  • triple tissue sampling (TTS) is a common practice
• manometry for sphincter of Oddi
• balloon dilation of the duodenal papilla or ductal strictures
• sphincterotomy (e.g. sphincter of Oddi dysfunction or stenosis)

Contraindications

• relative
  • altered anatomy in post-surgical states (e.g. Billroth II gastrojejunostomy, Roux-en-Y jejunostomy)
  • structural abnormalities of esophagus, stomach or duodenum
  • coagulopathy
• absolute
  • unstable patient

Complications

• pancreatitis (~5%)
• hemorrhage
• perforation leading to pneumoperitoneum and/or pneumoretroperitoneum
• infection (e.g. cholangitis)
• migration of a biliary or pancreatic duct stent
• complications secondary to endoscopy e.g. esophageal and gastric injury

Siehe auch:

• MRCP
• Gallenwegsstent
• Dormiakörbchen
• CT intravenous cholangiogram
• endoskopische Steinextraktion Gallenwege

und weiter:

• ERCP Komplikationen