Wednesday, August 18, 2010

ERCP - Diagnostic, Therapeutic, Contraindications

Diagnostic for ERCP

  • Obstructive jaundice - This may be due to several causes
  • Chronic pancreatitis - a now controversial indication due to widespread availability of safer diagnostic modalities including endoscopic ultrasound, high-resolution CT, and MRI/MRCP
  • Gallstones with dilated bile ducts on ultrasonography
  • Bile duct tumors
  • Suspected injury to bile ducts either as a result of trauma or iatrogenic
  • Sphincter of Oddi dysfunction
  • Pancreatic tumors no longer represent a valid diagnostic indication for ERCP unless they cause bile duct obstruction and jaundice. Endoscopic ultrasound represents a safer and more accurate diagnostic alternative 
Therapeutic

Any of the above when the following may become necessary
  • 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) 
Contraindications

  • Recent attack of acute pancreatitis, within the past several weeks.
  • Recent myocardial infarction.
  • Inadequate surgical back-up
  • History of contrast dye anaphylaxis
  • Poor health condition for surgery.
  • Severe cardiopulmonary disease.

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