Research Paper On Endoscopic Retrograde Cholangiopancreatography
What is ERCP (endoscopic retrograde cholangiopancreatography)?
By Jonas Wilson, Ing. Med.
ERCP is short for endoscopic retrograde cholangiopancreatography. It is a medical technique that employs a combination of fluoroscopy and endoscopy to diagnose and treat disorders affecting the biliary tree or pancreatic ducts. Conditions such as gall stones, inflammatory scars and cancer are primary indications for ERCP. ERCP may be used to for diagnostic purposes, however, there are safer alternative and non-invasive procedures available such as magnetic resonance cholangiopancreatography (MRCP). Hence, ERCP is used mainly where treatment is needed.
Indications
ERCP was first widely used as a diagnostic tool, dating back to the 1970s. However, …show more content…
contemporary usage is mainly for therapeutic purposes due to the availability of diagnostic modalities such as ultrasound (US), computed tomography (CT) and MRCP. ERCP is associated with a high risk of medical complications and as a result it is vital than the clinical indication for usage outweighs the potential complications. The American Society for Gastrointestinal Endoscopy (ASGE) has published guidelines with regards to the use of ERCP for pancreatic and biliary tree diseases.
According to the ASGE, indications for ERCP with pancreatic disease are for the assessment and treatment of:
• Symptomatic pancreatic duct stones
• Symptomatic strictures accompanying chronic pancreatitis
• Recurrent acute pancreatitis of unknown etiology
• Symptomatic pancreatic pseudocysts of pancreatic fluid collections (benign)
The ASGE guidelines also allow for the usage of ERCP to diagnose pancreatic malignancies when pancreatoscopy is required as well as bile duct brushing and biopsy and intraductal US. ERCP may also be used for the assessment and treatment of ampullary adenomas and malignancies.
The ASGE ERCP indications for biliary tract disease are for the assessment and treatment of:
• Biliary obstruction due to stones, especially in cases where jaundice is clinically evident
• Bile duct strictures that are congenital, benign or malignant
The use of ERCP as a routine procedure before a laparoscopic cholecystectomy is not an indication.
Contraindications
ERCP should be completely avoided in patients with underlying cardiovascular, neurological and cardiopulmonary complications that are at risk for further destabilization of their clinical status.
It is also absolutely contraindicated in patients that present with bowel perforation. Performing ERCP in these patients may result in potentially fatal consequences.
Relative indications to the procedure include anatomical abnormalities of the upper gastrointestinal tract (i.e. esophagus, stomach and duodenum). Anatomical abnormalities include, but are not limited to strictures, herniation, volvulus and obstruction. Patients with coagulopathies and those who present with acute pancreatitis are also placed into this category. The exception in acute pancreatitis is if it is caused by gallstones and stone removal is necessary with ERCP.
Risk factors
There are a number of risk factors associated with ERCP. These include, but are not limited to infections, allergic reaction to the sedatives used in the procedure, pancreatitis, hemorrhage, inadvertent puncturing of the GI tract or ducts and in rare circumstances death. It is important that patients who have undergone ERCP look out for symptoms such as difficulties swallowing, vomiting, fever and pain in the abdomen, chest or throat that is worsening. Experiencing these symptoms requires affected patients to seek urgent medical
care.
References
• https://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/ercp/Pages/diagnostic-test.aspx
•
By Jonas Wilson, Ing. Med.
ERCP is short for endoscopic retrograde cholangiopancreatography. It is a medical technique that employs a combination of fluoroscopy and endoscopy to diagnose and treat disorders affecting the biliary tree or pancreatic ducts. Conditions such as gall stones, inflammatory scars and cancer are primary indications for ERCP. ERCP may be used to for diagnostic purposes, however, there are safer alternative and non-invasive procedures available such as magnetic resonance cholangiopancreatography (MRCP). Hence, ERCP is used mainly where treatment is needed.
Indications
ERCP was first widely used as a diagnostic tool, dating back to the 1970s. However, …show more content…
contemporary usage is mainly for therapeutic purposes due to the availability of diagnostic modalities such as ultrasound (US), computed tomography (CT) and MRCP. ERCP is associated with a high risk of medical complications and as a result it is vital than the clinical indication for usage outweighs the potential complications. The American Society for Gastrointestinal Endoscopy (ASGE) has published guidelines with regards to the use of ERCP for pancreatic and biliary tree diseases.
According to the ASGE, indications for ERCP with pancreatic disease are for the assessment and treatment of:
• Symptomatic pancreatic duct stones
• Symptomatic strictures accompanying chronic pancreatitis
• Recurrent acute pancreatitis of unknown etiology
• Symptomatic pancreatic pseudocysts of pancreatic fluid collections (benign)
The ASGE guidelines also allow for the usage of ERCP to diagnose pancreatic malignancies when pancreatoscopy is required as well as bile duct brushing and biopsy and intraductal US. ERCP may also be used for the assessment and treatment of ampullary adenomas and malignancies.
The ASGE ERCP indications for biliary tract disease are for the assessment and treatment of:
• Biliary obstruction due to stones, especially in cases where jaundice is clinically evident
• Bile duct strictures that are congenital, benign or malignant
The use of ERCP as a routine procedure before a laparoscopic cholecystectomy is not an indication.
Contraindications
ERCP should be completely avoided in patients with underlying cardiovascular, neurological and cardiopulmonary complications that are at risk for further destabilization of their clinical status.
It is also absolutely contraindicated in patients that present with bowel perforation. Performing ERCP in these patients may result in potentially fatal consequences.
Relative indications to the procedure include anatomical abnormalities of the upper gastrointestinal tract (i.e. esophagus, stomach and duodenum). Anatomical abnormalities include, but are not limited to strictures, herniation, volvulus and obstruction. Patients with coagulopathies and those who present with acute pancreatitis are also placed into this category. The exception in acute pancreatitis is if it is caused by gallstones and stone removal is necessary with ERCP.
Risk factors
There are a number of risk factors associated with ERCP. These include, but are not limited to infections, allergic reaction to the sedatives used in the procedure, pancreatitis, hemorrhage, inadvertent puncturing of the GI tract or ducts and in rare circumstances death. It is important that patients who have undergone ERCP look out for symptoms such as difficulties swallowing, vomiting, fever and pain in the abdomen, chest or throat that is worsening. Experiencing these symptoms requires affected patients to seek urgent medical
care.
References
• https://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/ercp/Pages/diagnostic-test.aspx
•