I. What is ERCP?
ERCP is to insert the duodenoscope into the descending duodenum, find the duodenal papilla, insert a contrast catheter through the endoscopic operation orifice, enter the duodenal papilla and inject the contrast agent, if the pancreatic duct and bile duct are visualized at the same time or successively, it is called ERCP. Although MRCP examination is non-invasive, it has a high misdiagnosis rate and has no therapeutic effect, so it cannot replace the role of ERCP; with the development of medical technology, ERCP has evolved from a simple diagnostic imaging to a modern diagnostic technique that combines imaging with cytology, histology, pancreatic fluid and bile biochemistry, tumor marker detection and genetic diagnosis. There is also rapid development in therapeutic ERCP, including endoscopic papillary sphincterotomy, lithotomy, bile duct stent drainage, nasobiliary duct drainage, bile duct multi-stent duct drainage, bile-pancreatic duct double-stent drainage, pancreatic duct sphincterotomy, pancreatic duct lithotomy, nasopancreatic duct drainage, pancreatic pseudocyst drainage, etc., which make ERCP diagnosis and treatment technology enter a new era. At present, our department can perform the above operations.
Which patients need ERCP?
It is generally considered that all patients with suspected pancreaticobiliary diseases are indications, mainly including.
1.Suspected bile duct stone, tumor, inflammation, parasite or obstructive jaundice with unknown cause.
2. Recurrence of symptoms after cholecystectomy or bile duct surgery.
3, clinical suspicion of pancreatic tumor, chronic pancreatitis or recurrent pancreatitis in remission.
4.Suspected inflammation or tumor of the duodenal papilla or jugular abdomen, and biliary pancreatitis to remove the cause.
5.Suspected congenital malformation such as common bile duct cyst and pancreaticobiliary duct confluence abnormalities.
6.Understood epigastric pain and suspected pancreaticobiliary tract disease.
7.Biliary and pancreatic disorders requiring collection of bile and pancreatic fluid or Oddi sphincter manometry.
8. Those who need endoscopic treatment for pancreaticobiliary disorders.
9.Pancreatic duct rupture suspected after pancreatic trauma.
10.Bile leakage after bile duct surgery, suspected of misuse.
11.Suspected congenital lesions of the pancreas.
12, certain liver disorders, such as hepatocellular carcinoma with obstructive jaundice, intra- and extra-hepatic bile duct stones with intrahepatic cholangitis.
Acute cholangitis, biliary acute pancreatitis and pancreatic cysts used to be considered as contraindications to ERCP, but in recent years, due to the development of duodenoscopic drainage technology, they are now considered not contraindicated, but have become the preferred treatment, and endoscopic diagnosis and treatment should be performed as soon as possible when conditions are available.
Contraindications to ERCP
1. Those who have upper gastrointestinal stenosis or obstruction and are estimated to be unlikely to reach the descending duodenum.
2. Those who have other contraindications to endoscopy such as severe cardiopulmonary dysfunction.
3.Non-stone embedded acute pancreatitis or acute attack of chronic pancreatitis.
4.Patients with bile duct stricture or obstruction who do not have bile duct drainage technique.
5, abnormal coagulation function, psychiatric episodes.