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
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
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
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
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
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
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
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
