Endoscopic retrograde cholangiopancreatography: diagnostic and therapeutic

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized procedure for the management of biliary and pancreatic diseases using a combination of endoscopic and fluoroscopic guidance. The role of diagnostic ERCP is now primarily reserved for conditions in which the diagnosis remains elusive despite evaluation using noninvasive imaging and endoscopic ultrasound (EUS). Extracorporeal shock wave lithotripsy (ESWL) may be used alone or as an adjunct to ERCP for pancreatic stone removal. ERCP is often offered in the hope of alleviating pain and breaking the cycle of recurrent attacks by optimizing drainage from the pancreatic orifice through pancreatic sphincterotomy and/or stent placement. Surgical procedures that result in alterations of the gastric, duodenal, and/or biliary anatomy may result in anatomic changes that make ERCP access to the major papilla/biliary tree technically difficult or impossible.