Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines endoscopy and fluoroscopy to diagnose and treat problems of the biliary and pancreatic ductal systems. ERCP was originally used for diagnostic purposes but is now commonly used therapeutically. It allows visualization of the bile and pancreatic ducts and can be used to perform sphincterotomies, remove stones, place stents, and dilate strictures. ERCP has advantages over surgery as it is less invasive but also has risks of pancreatitis, bleeding, perforation and infection. Contraindications include acute pancreatitis, previous pancreatoduodenectomy, coagulation disorders if sphincterotomy planned, or

1. Endoscopic retrograde
cholangiopancreatography (ERCP)
MARYAM MAJID AL-EZAIREJ
DEPARTMENT OF GENERAL SURGERY
COLLAGE OF MEDICINE, RAKMHSU

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

13. REFERENCES
 www.slideshare.net
 emedicine.medscape.com
 www.medic8.com
 www.ddc.musc.edu

14. ANY QUESTION ?
THANK YOU 