Endoscopic “Retrograde” Cholangiopancreatography (ERCP)



Cannulation of the ampulla of Vater is carried out using a special side-viewing endoscope. This is technically the most difficult endoscopic ex­amination to perform. Once cannulation is achieved, selective intubation of the pancreatic and common bile ducts is undertaken followed by injection of a radiographic contrast medium. Radiographs are taken of the contrast-outlined ducts. Indications for ERCP include the diagnosis of pancreatic cancer, investigation of obstructive jaundice, placement of biliary stents, and per­formance of endoscopic sphincterotomy. In ob­structive jaundice, ERCP is preferred to percuta­neous cholangiography if duct dilatation is absent, if there is associated pancreatic or duo­denal pathology, or if a coagulation defect is present. Detailed comparison of ERCP with per­cutaneous cholangiography is given in .

Endoscopic sphincterotomy entails an electro­cautery incision into the duodenal papilla and is used to release retained common duct gallstones in patients who have already undergone chole­cystectomy (and who would otherwise require a second operation) and in those patients consid­ered poor surgical risks. The morbidity rate from sphincterotomy is 8 per cent, and the mortality rate is 1 per cent.







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