2. OBJECTIVES
Define ERCP
Describe its uses
Outline briefly the procedure of ERCP
Explain the advantages and disadvantages of ERCP
Outline its complications, risk, and contraindication
3. WHAT IS ERCP ?
Endoscopic retrograde
cholangiopancreatography is a technique that
combines the use
of endoscopy and fluoroscopy to diagnose and
treat certain problems of the biliary or pancreatic
ductal systems.
4. USES OF ERCP
Ercp was first used n 1970s, at the time it was used for
diagnostic purpose mainly but now a days it is used for
both therapeutics as well as diagnostic although it is
used for therapeutics more .
5. DIAGNOSTIC USES OF ERCP
Obstructive jaundice
Chronic pancreatitis
Gallstones with dilated bile ducts on ultrasonography
Bile duct tumors
Pancreatic tumors
Suspected injury to bile ducts either as a result of trauma
or iatrogenic
6. THERAPEUTIC USES OF ERCP
Endoscopic sphincterotomy (both of the biliary and
the pancreatic sphincters)
Removal of stones
Insertion of stent(s)
Dilation of strictures (e.g. primary sclerosing
cholangitis, anastomotic strictures after liver
transplantation)
7. BEFORE ERCP
Before the patient undergoes the ercp several steps
must be taken.
CBC and clotting screening
Respiratory and CVS assessment
Prophylactic antibiotics should be administered to
patient with biliary obstruction
The patient should be fasting overnight
8. PROCEDURE OF ERCP
The patient is under general anesthesia and lied on his
left side
A side-viewing duodenoscopy is passed through the
pylorus and into the second part of duodenum to
visualize ampulla of vater, it is then cannulated into it.
By adjusting the angle of the endoscope it can be
either cannulated into the common bile duct or into
the pancreatic duct which is then visualized with a
fluoroscopy.
9. ADVANTAGES OF ERCP
Safe and highly effective diagnostic technique
Accurate method of diagnosing and treating
conditions of the bile and pancreatic ducts
Simpler than exploratory surgery
Can prevent the need for major abdominal surgery
May help with planning for surgery
10. DISADVANTAGES OF ERCP:
Complications rarely occur. Possible complications include
bowel perforation or hemorrhage, which might require
surgical repair or blood transfusion respectively
Risk of perforation or hemorrhage is increased when polyps
are removed via the endoscope
The procedure requires a hospital stay
Sedation is required, with a small risk of adverse reactions to
medications used
There is a degree of patient discomfort
11. COMPLICATIONS OF ERCP
Pancreatitis (2-9%) is the most common
complication of ercp
Bleeding
Infection even though it occurs it a very low rate
Perforation rates with ERCP range from 0.1% to
0.6%.
12. Contraindication of ERCP
ERCP is contraindicated in patients of :
Acute pancreatitis
Previous pancreatoduodenectomy
Coagulation disorder if sphincterotomy planned
Recent myocardial infarction
history of contrast dye anaphylaxis