Issues to be concerned in curative endoscopic retrograde cholangiopancreatography

Bing Hu, MD

Endoscopy Center, West China Hospital, Sichuan University, Chengdu, 610041, China

Over the past 40 years, endoscopic retrograde cholangiopancreatography (ERCP) has greatly changed the diagnosis and treatment of biliary and pancreatic diseases. With its increasing success rate, curative ERCP has replaced surgery in the treatment of some diseases.

ERCP and laparoscopic cholecystectomy (LC) are two most commonly used methods in the treatment of cholelithiasis.

The indications for ERCP applied before and after LC as well as the order and timing of ERCP and LC need to be carefully considered.

As for emergent and critical patients, all preparation must be done well in advance and the procedure should be simple as long as it is effective. Two main methods for treating basket incarceration are needleknife sphincterotomy and urgent lithotripsy.

When a diverticulum is found in duodenum, there will be higher risks and difficulties in ERCP. Intrahepatic cholelithiasis is usually treated by open surgery, but ERCP is required in some conditions.

Bleeding is one of the most common complications of endoscopic sphincterotomy (EST) and can be either intraoperative or delayed. Some precautions are as follows:

(1) Relieve jaundice, improve coagulation function, stop using anticoagulants and stabilize comorbidities before EST.
(2) Pay attention to cutting speed and the size of the cut.
(3) Postoperative fasting, administration of hemostatic agents and monitoring of coagulation function after EST. Treatments for controlling bleeding include spraying norepinephrine solution, submucosal injection of epinephrine-saline solution, electric coagulation, argon plasma coagulation (APC) and the use of titanium clips.

Curative ERCP has proved to be an effective method in treating many biliary and pancreatic diseases, but its indications and complications are not to be ignored.