Endoscopic retrograde cholangiopancreatography (ERCP)

Indications

Demonstrates cause, location, and extent of extrahepatic biliary obstruction (eg, choledocholithiasis).

Can diagnose chronic pancreatitis.

Primary sclerosing cholangitis, AIDS-associated cholangitis, and cholangiocarcinomas.

Advantages

Avoids surgery.

Less invasive than percutaneous transhepatic cholangiography.

Offers therapeutic potential (sphincterotomy and extraction of common bile duct stone, balloon dilatation of strictures, placement of stents).

Finds gallstones in up to 14% of patients with symptoms but negative ultrasound.

Disadvantages/Contraindications

Requires endoscopy. May cause pancreatitis (1%), cholangitis (<1%), peritonitis, hemorrhage (if sphincterotomy performed), and death (rare).

Contraindications and risks: Relatively contraindicated in patients with concurrent or recent (<6 weeks) acute pancreatitis or suspected pancreatic pseudocyst. Contraindicated in pregnancy because of the potential harm of ionizing radiation to the fetus.

Preparation

NPO for 6 hours.

Sedation required.

Vital signs should be monitored by the nursing staff.

Not possible in patient who has undergone Roux-en-Y hepaticojejunostomy.