Diagnostic Endoscopic Retrograde Cholangiopancreatography

Introduction

The United States National Institutes of Health (NIH) State of the Science Conference Statement, published in 2002 [1], reviewed the current indications and future directions for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In biliary stone disease, magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) have replaced purely diagnostic ERCP. In cases of advanced pancreatic malignancy in which chemoradiotherapy is indicated, ERCP may be one of the modalities for tissue sampling by needle aspiration, brush cytology, or forceps biopsy, alone or in combination with other techniques. ERCP is the best method of diagnosis for ampullary malignancies. It is also useful for diagnosing biliary malignancy in patients with underlying sclerosing cholangitis. Purely diagnostic ERCP has no role in acute or chronic pancreatitis. In recurrent pancreatitis of unknown cause, ERCP with sphincter manometry should be used if MRCP or computed tomography (CT) are negative, or should be used without manometry if pancreas divisum is suspected. Purely diagnostic ERCP has no role in the diagnosis of abdominal pain of possible pancreatic or biliary origin. This NIH statement, which is open to discussion, illustrates the way in which the role of diagnostic ERCP is becoming increasingly limited due to the emergence of noninvasive techniques such as MRCP and EUS.

The present review discusses the literature on diagnostic ERCP published from July 2002, the latest date covered in the previous review by Schöfl and Haefner [2], to August 2003.

References

• 1 Cohen S, Bacon B R, Berlin J A. et al . National Institutes of Health State-of-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14-16, 2002.  Gastrointest Endosc. 2002;  56 803-809
• 2 Schöfl R, Haefner M. Diagnostic cholangiopancreatography.  Endoscopy. 2002;  35 145-155
• 3 American Society for Gastrointestinal Endoscopy. Complications of ERCP.  Gastrointest Endosc. 2003;  57 633-638
• 4 Vandervoort J, Soetikno R M, Tham T CK. et al . Risk factors for complications after performance of ERCP.  Gastrointest Endosc. 2002;  56 652-656
• 5 Freeman M L. Adverse outcomes after ERCP.  Gastrointest Endosc. 2002;  56 S273-S282
• 6 Aronson N, Flamm C R, Bohn R L. et al . Evidence based assessment: patient, procedure or operator factors associated with ERCP complications.  Gastrointest Endosc. 2002;  56 S294-S302
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• 8 Nelson D B. Infectious disease complications of GI endoscopy, 2: exogenous infections.  Gastrointest Endosc. 2003;  57 S695-S711
• 9 Andriulli A, Clemente R, Solmi L. et al . Gabexate or somatostatin administration before ERCP in patients at high-risk for post-ERCP pancreatitis: a multicenter, placebo controlled, randomized clinical trial.  Gastrointest Endosc. 2002;  56 488-495
• 10 Prat F, Amaris J, Ducot B. et al . Nifedipine for prevention of post-ERCP pancreatitis: a prospective, double-blind randomized study.  Gastrointest Endosc. 2002;  56 202-208
• 11 Moreto M, Zaballa M, Casando I. et al . Transdermal glyceryl trinitrate for prevention of post-ERCP pancreatitis: a randomized double-blind trial.  Gastrointest Endosc. 2003;  57 1-7
• 12 Sherman S, Blaut U, Watkins J L. et al . Does prophylactic administration of corticosteroid reduce the risk and severity of post-ERCP pancreatitis: a randomized, prospective, multicenter study.  Gastrointest Endosc. 2003;  58 23-29
• 13 Murray B, Carter R, Imrie C. et al . Diclofenac reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography.  Gastroenterology. 2003;  124 1786-1791
• 14 He Z J, Winston J H, Yusuf T E. et al . Intraductal administration of an NK1 receptor antagonist attenuates the inflammatory response to retrograde infusion of radiological contrast in rats: implications for the pathogenesis and prevention of ERCP induced pancreatitis.  Pancreas. 2003;  27 E13-E17
• 15 Christensen M, Hendel H W, Rasmussen W. et al . Endoscopic retrograde cholangiopancreatography caused reduced myocardial blood flow.  Endoscopy. 2002;  34 797-800
• 16 Carlos R C, Scheiman J M, Hussain H K. et al . Making cost-effectiveness analysis clinically relevant: the effect of provider expertise and biliary disease prevalence on the economic comparison of alternative diagnostic strategies.  Acad Radiol. 2003;  10 620-630
• 17 Igarashi Y, Tada T, Shimura J. et al . A new cannula with a flexible tip (swing tip) may improve the success rate of endoscopic cholangiopancreatography.  Endoscopy. 2002;  34 628-631
• 18 Laasch H U, Tringali A, Wilbraham L. et al . Comparison of standard and steerable catheters for bile duct cannulation ERCP.  Endoscopy. 2003;  35 669-674
• 19 Nawras A T, Catalano M F, Alsolaiman M M. et al . Overtube-assisted ERCP in patients with altered gastric and esophageal anatomy.  Gastrointest Endosc. 2002;  56 426-430
• 20 Kato S, Kamagata S, Asakura T. et al . A newly developed small-calibre videoduodenoscope for endoscopic retrograde cholangiopancreatography in children.  J Clin Gastroenterol. 2003;  37 173-176
• 21 Rajnakova A, Goh P M, Ngoi S S. et al . ERCP in patients with periampullary diverticulum.  Hepatogastroenterology. 2003;  50 625-628
• 22 Park H S, De Bellis M, McHenry L. et al . Use of methylene blue to identify the minor papilla or its orifice in patients with pancreas divisum.  Gastrointest Endosc. 2003;  57 358-363
• 23 Devereaux B M, Fein S, Purich E. et al . A new synthetic porcine secretin for facilitation of cannulation of the dorsal pancreatic duct at ERCP in patients with pancreas divisum: a multicenter, randomized, double-blind comparative study.  Gastrointest Endosc. 2003;  57 643-647
• 24 Wehrmann T, Grotcamp J, Stergiou N. et al . Electroencephalogram monitoring facilitates sedation with propofol for routine ERCP: a randomized controlled trial.  Gastrointest Endosc. 2002;  56 817-824
• 25 Vargo J J, Zuccaro G, Dumot J A. et al . Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective randomized trial.  Gastroenterology. 2002;  123 8-16
• 26 Heuss L T, Schnieper P, Drewe J. et al . Risk stratification and safe administration of propofol by registered nurse supervised by the gastroenterologist: a prospective observational study of more than 2000 cases.  Gastrointest Endosc. 2003;  57 664-671
• 27 Raymondos K, Panning B, Bachem I. et al . Evaluation of endoscopic retrograde cholangiopancreatography under conscious sedation and general anesthesia.  Endoscopy. 2002;  34 721-726
• 28 Luman W, Chan E S. Mathematical model for predicting biliary therapeutic endoscopic retrograde pancreatography (ERCP).  Dig Liver Dis. 2003;  35 486-492
• 29 Byrne M F, Baillie J. Predicting the likelihood of therapeutic ERCP: a suggested ”model” to limit the number of purely diagnostic ERCPs.  Dig Liver Dis. 2003;  35 458-460
• 30 Enns R, Eloubeidi M A, Mergener K. et al . Predictors of successful clinical and laboratory outcomes in patients with primary sclerosing cholangitis undergoing endoscopic retrograde cholangiopancreatography.  Can J Gastroenterol. 2003;  17 243-248
• 31 Coyle W J, Pineau B C, Tarnasky P R. et al . Evaluation of unexplained acute and acute recurrent pancreatitis using endoscopic retrograde pancreatography, sphincter of Oddi manometry and endoscopic ultrasound.  Endoscopy. 2002;  34 617-623
• 32 Unno H, Saegusa H, Fukushima M. et al . Usefulness of endoscopic observation of the main duodenal papilla in the diagnosis of sclerosing pancreatitis.  Gastrointest Endosc. 2002;  56 880-884
• 33 Rulyak S J, Kimmey M B, Veenstra D L. et al . Cost-effectiveness of pancreatic cancer screening in familial pancreatic cancer kindreds.  Gastrointest Endosc. 2003;  57 23-29
• 34 Kimmey M B, Bronner M B, Byrd D R. et al . Screening and surveillance for hereditary pancreatic cancer.  Gastrointest Endosc. 2002;  56 S82-S86
• 35 Tann M, Maglinte D, Howard T J. et al . Disconnected pancreatic duct syndrome: imaging findings and therapeutic implications in 26 surgically corrected patients.  J Comput Assist Tomogr. 2003;  27 577-582
• 36 Firoozi B, Choung R, Diehl D L. Bile duct dilation with chronic methadone use in asymptomatic patients: ERCP findings in 6 patients.  Gastrointest Endosc. 2003;  58 127-130
• 37 Textor H J, Flacke S, Pauleit D. et al . Three-dimensional magnetic resonance cholangiopancreatography with respiratory triggering in the diagnosis of the primary sclerosing cholangitis: comparison with endoscopic retrograde cholangiography.  Endoscopy. 2002;  34 984-990
• 38 Weber C, Krupski G, Lorenzen J. et al . MRCP in primary sclerosing cholangitis [in German].  Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr. 2003;  175 203-210
• 39 Chen R C, Lin K Y, Lii J M. et al . MR cholangiopancreatography: prospective comparison of 3-dimensional turbo spin echo and single-shot turbo spin echo with ERCP.  J Formos Med Assoc. 2003;  102 172-177
• 40 Griffin N, Wastle M L, Dunn W K. et al . Magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography in the diagnosis of choledocholithiasis.  Eur J Gastroenterol Hepatol. 2003;  15 809-813
• 41 Kats J, Kraai M, Dijkstra A J. et al . Magnetic resonance cholangiopancreatography as a diagnostic tool for common bile duct stones: a comparison with ERCP and clinical follow-up.  Dig Surg. 2003;  20 32-37
• 42 Di Cesare E, Puglielli E, Michelini O. et al . Malignant obstructive jaundice: comparison of ERCP and ERCP in the evaluation of distal lesions.  Radiol Med (Torino). 2003;  105 445-453
• 43 Napoleon B, Dumortier J, Keriven-Souquet O. et al . Do normal findings at biliary endoscopic ultrasonography obviate the need for endoscopic retrograde cholangiography in patients with suspicion of common duct bile stone? A prospective follow-up study of 238 patients.  Endoscopy. 2003;  35 411-415
• 44 Catanzarro A, Pfau P, Isenberg G A. et al . Clinical utility of intraductal EUS for evaluation of choledocholithiasis.  Gastrointest Endosc. 2003;  57 712-714
• 45 Wehrmann T, Martchenko K, Menke D. et al . Clinical value of intraductal ultrasonography for clarification of confusing ERCP results [in German].  Dtsch Med Wochenschr. 2003;  128 863-869
• 46 Wehrman T, Stergiou N, Schmitt T. et al . Reduced risk for pancreatitis after endoscopic transducer manometry of the sphincter of Oddi: a randomized comparison with the perfusion manometry technique.  Endoscopy. 2003;  35 472-477
• 47 Bin-Sagheer S T, Brady P G, Mamel J J. et al . Reduction in the incidence of pancreatitis in patients undergoing sphincter of Oddi manometry: a successful quality improvement project.  South Med J. 2003;  96 223-225
• 48 Lindberg B, Arnelo U, Bergquist A. et al . Diagnosis of biliary strictures in conjunction with endoscopic retrograde cholangiopancreatography, with special reference to patients with primary sclerosing cholangitis.  Endoscopy. 2002;  34 909-916
• 49 De Bellis M, Fogel E L, Sherman S. et al . Influence of stricture dilation and repeat brushing on the cancer detection rate of brush cytology in the evaluation of malignant biliary obstruction.  Gastrointest Endosc. 2003;  58 176-182
• 50 Kodama T, Tatsumi Y, Kozarek R A, Riemann J F. Direct pancreatoscopy.  Endoscopy. 2002;  34 653-660
• 51 Yamao K, Ohashi K, Nakamura T. et al . Efficacy of peroral pancreatoscopy in the diagnosis of pancreatic diseases.  Gastrointest Endosc. 2003;  57 205-209
• 52 Kodama T, Imamura Y, Sato H. et al . Feasibility study using a new small electronic pancreatoscope: description of findings in chronic pancreatitis.  Endoscopy. 2003;  35 305-310
• 53 Ueno N, Ozawa Y, Aizawa T. Pancreatoscopy assisted by endoscopic sphincter dilation.  J Gastroenterol. 2003;  38 283-287
• 54 Fallone C A, Tran S, Semret M. et al . Helicobacter DNA in bile: correlation with hepatobiliary diseases.  Aliment Pharmacol Ther. 2003;  17 453-458
• 55 Klump B, Hsieh C J, Nehls O. et al . Methylation status of p14ARF and p16INK4a as detected in pancreatic secretions.  Br J Cancer. 2003;  88 217-222