Endoscopic retrograde cholangiopancreatography (ERCP).&&Magnetic resonance cholangiopancreatography (MRCP)

 Endoscopic retrograde cholangiopancreatography (ERCP)

 

      Principle 

 

Examination of the duodenum, accessory papilla, major papilla, biliary and/or pancreatic ducts.

 

 

           Diagnostic ERCP 

 

• Biliary or pancreatic disease where other    

imaging is equivocal or is contraindicated 

 

• Ampullary biopsy or biliary cytology 

 

                Therapeutic ERCP 

 

 

Biliary disease 

 

• Removal of common bile duct calculi

• Palliation of malignant biliary obstruction 

• Management of biliary leaks/damage complicating surgery 

• Dilatation of benign strictures 

• Primary sclerosing cholangitis
Pancreatic disease 

• Drainage of pancreatic pseudocysts and fistulae 

• Removal of pancreatic calculi (selected cases)

 

 

 

 

        Preparation:

 

 

As for OGD.

• Stop acid suppression therapy for 2 weeks.

• Nil by mouth 4–6h prior.

 

Results 

 

Findings in biliary system 

• Cholangiocarcinoma 

• Papillary stenosis 

• Choledocholithiasis 

• Liver metastasis 

• Juxtapapillary diverticulum 

• Primary sclerosing cholangitis Surgical ligation of bile duct 2 Normal findings 7

 

• Caroli syndrome 

• Ischaemic biliary lesion
Pancreatic system 

• Chronic pancreatitis 

• Pancreatic carcinoma 

• Pancreas divisum 

• Pancreatolithiasis 

• Acute pancreatitis 

• Pancreatic lymphoma 

 

         Advantage 

 

• Has replaced previous surgical intervention.

• Allows therapeutic intervention over MRCP.

 

        Contraindications 

• Severe cardiopulmonary comorbidity 

• Coagulopathy 

       Complications 

 

(Occur in 5–10% with a 30-day mortality of 0.5–1%)

 

    General 

• Cardiorespiratory depression due to sedation 

• Aspiration pneumonia 

• Perforation 

 

     Specific 

• Biliary disease 

◦ Bleeding following sphincterotomy
◦ Cholangitis (if biliary obstruction is not relieved  by ERCP)
◦ Gallstone impaction 

 

• Pancreatic disease 

   Acute pancreatitis

   Infection of pseudocyst.

Magnetic resonance cholangiopancreatography (MRCP)

 

 

 

Introduction 

 

MRCP includes heavily T2 weighed sequences that show stationary or slow- moving fluid like bile. It is non- invasive and radiation free.

 

 

Preparation 

Patient should be empty stomach for 8-12 hours to avoid any fluid in stomach.

 

 

Application of MRCP 

1. It is as effective as ERCP in evaluating choledochal cyst, choledochocele and Caroli’s disease.

 

2. Congenital anomalies: It is superior to ERCP in detecting pancreatic divisum. MRCP can non invasively diagnose biliary atresia.

 

3. Choledocholithiasis: MRCP is excellent method to detect stone.

 

4. MRCP is useful in the diagnosis and followup of primary sclerosing cholangitis.

 

5. Post surgical complication: MRCP is excellent in follow up complications like benign strictures, retained stone, biliary fistula.

 

 

 
6. MRCP is useful for detecting chronic pancreatitis 

.
7. It is also useful to detect neoplasm causing obstruction: cholangiocarcinoma, pancreatic head carcinoma.

 

8. Secretin MRCP is useful for functional imaging and improved anatomic depiction of pancreatic ductal system.

 

9. Images of the biliary tree and pancreas complements that of CT and endoscopic ultrasound examination (EUS).

 

10. Non-operator dependant 

 

 

Disadvantage 

• Cannot offer therapeutic intervention
• High cost
• Claustrophobia 

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