Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Urethral catheterization
- Percutaneous suprapubic catheterization
- Vascular access
- Arterial cannulation
- Central line insertion
- Lumbar puncture
- Airway
- Chest drain insertion
- Thoracocentesis
- Pericardiocentesis
- Nasogastric tubes
- Abdominal paracentesis
- Diagnostic peritoneal lavage (DPL)
- Rigid sigmoidoscopy
- Proctoscopy
- Oesophago-gastro-duodenoscopy (OGD)
- Endoscopic retrograde cholangio-pancreatography (ERCP)
- Colonoscopy and flexible sigmoidoscopy
- Local anaesthesia
- Regional nerve blocks
- Sutures
- Bowel anastomoses
- Skin grafts and flaps
- Principles of laparoscopy
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Endoscopic retrograde cholangio-pancreatography (ERCP)
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Urethral catheterization
- Percutaneous suprapubic catheterization
- Vascular access
- Arterial cannulation
- Central line insertion
- Lumbar puncture
- Airway
- Chest drain insertion
- Thoracocentesis
- Pericardiocentesis
- Nasogastric tubes
- Abdominal paracentesis
- Diagnostic peritoneal lavage (DPL)
- Rigid sigmoidoscopy
- Proctoscopy
- Oesophago-gastro-duodenoscopy (OGD)
- Endoscopic retrograde cholangio-pancreatography (ERCP)
- Colonoscopy and flexible sigmoidoscopy
- Local anaesthesia
- Regional nerve blocks
- Sutures
- Bowel anastomoses
- Skin grafts and flaps
- Principles of laparoscopy
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Definitions
Endoscopic retrograde cholangio-pancreatography (ERCP) is the passage of an endoscope to the second part of the duodenum allowing access to the major papilla, and the subsequent cannulation of the biliary and/or pancreatic ductal systems. These are opacified by injection of contrast media permitting their visualization and allowing for a variety of therapeutic interventions.
ERCP is a complex endoscopic procedure with a similar level of risk to some major operations; consequently it needs to be carefully planned. Since the advent of more advanced non-invasive imaging, i.e. magnetic resonance cholangio-pancreatography (MRCP) and endoscopic ultrasound, the majority of ERCPs performed are therapeutic rather than diagnostic. Pancreatic therapy and biliary manometry is usually only performed in specialist centres.
Indications
COMMON
▪ Removal of common bile duct stones prior to or after cholecystectomy.
▪ Diagnosis and stenting of biliary strictures; malignant (pancreatic cancer, cholangiocarcinoma) and benign (inflammatory, postoperative). Brushing the stricture can provide cytological samples.
OTHER
▪ Diagnosis of obstructive jaundice if other imaging inconclusive e.g. to confirm primary sclerosing cholangitis.
▪ Endoscopic therapy of postoperative biliary leaks i.e. by stenting.
▪ Severe gallstone pancreatitis, associated with biliary obstruction (early intervention with ERCP reduces morbidity and mortality).
▪ Investigation and treatment of recurrent acute pancreatitis e.g. by diagnosing and treating pancreatic duct stones and strictures.
▪ Diagnosis of ‘sphincter of Oddi dysfunction’ by biliary manometry.
Procedure
PRE-PROCEDURE CONSIDERATIONS
To keep your endoscopist happy, patients should be sent for ERCP with consent performed, a cannula in the left arm and a recent FBC and clotting screen clearly visible in the notes.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 654 - 658Publisher: Cambridge University PressPrint publication year: 2009