Overview

ERCP (Endoscopic Retrograde Cholangiopancreatography) is a procedure used to diagnose and treat conditions of the bile ducts and pancreas. It combines endoscopy and fluoroscopy.

ERCP is crucial for treating biliary obstruction, removing common bile duct stones, and diagnosing pancreaticobiliary diseases. It provides both diagnostic and therapeutic capabilities.

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Indications

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Biliary Obstruction

Jaundice, cholestasis

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Common Bile Duct Stones

Choledocholithiasis

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Pancreatic Disease

Pancreatitis, strictures

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Biliary Strictures

Benign or malignant strictures

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Sphincter of Oddi Dysfunction

Functional biliary disorder

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Uncorrected coagulopathy
✗ Perforation

Relative Contraindications

✗ Recent pancreatitis
✗ Pregnancy
✗ Severe cardiopulmonary disease

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient consent, fasting, positioning, equipment setup, and team briefing. All team members should understand their roles.

Step-by-Step Procedure

Step 1: Patient Preparation

Position patient, administer sedation, insert endoscope.

⚠️ Common Mistakes to Avoid:

  • Poor positioning
  • Inadequate sedation

💡 Pro Tip:

Position patient in left lateral position.

Step 2: Duodenal Intubation

Advance endoscope to duodenum, identify papilla.

⚠️ Common Mistakes to Avoid:

  • Failed intubation
  • Missed papilla

💡 Pro Tip:

Identify major papilla carefully.

Step 3: Cannulation

Cannulate bile duct or pancreatic duct.

⚠️ Common Mistakes to Avoid:

  • Failed cannulation
  • Wrong duct

💡 Pro Tip:

Use appropriate catheter and guidewire.

Step 4: Contrast Injection

Inject contrast for fluoroscopic imaging.

⚠️ Common Mistakes to Avoid:

  • Poor imaging
  • Contrast extravasation

💡 Pro Tip:

Inject contrast carefully under fluoroscopy.

Step 5: Intervention

Perform necessary therapeutic procedures.

⚠️ Common Mistakes to Avoid:

  • Incomplete procedure
  • Complications

💡 Pro Tip:

Complete all planned interventions.

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Post-procedure Care

Post-procedure care involves monitoring for complications, pain management, and follow-up imaging if needed.

Complications & Management

Complication Incidence Signs Management Prevention
Pancreatitis 3-8% Abdominal pain, elevated amylase Supportive care, monitoring Gentle technique, minimal contrast
Bleeding 1-3% Melena, hematemesis Endoscopic hemostasis Proper sphincterotomy technique
Perforation 0.5-1% Severe pain, free air Surgical repair Careful technique
Infection 1-2% Fever, chills Antibiotics Prophylactic antibiotics

Clinical Pearls

💡

Position patient in left lateral position.

🎯

Identify major papilla carefully.

⚡

Use appropriate catheter and guidewire.

🔍

Inject contrast carefully under fluoroscopy.

📊

Complete all planned interventions.

🎨

Monitor for complications post-procedure.

⚠️

Gentle technique prevents pancreatitis.