Pancreatography (Including Pancreatic Sphincterotomy and Difficult Cannulation)

Endoscopic retrograde cholangiopancreatography (ERCP) is now mostly indicated for biliary and pancreatic therapeutic interventions. Diagnostic pancreatography has been largely replaced by other non/less invasive techniques including magnetic resonance cholangiopancreatography and endoscopic ultrasound. ERCP complications are best reduced by performing the procedures only when indications are appropriate. ERCP is still a dominant technique for relief of biliary and pancreatic obstruction, whether benign or malignant. Temporary pancreatic duct stenting has shown to reduce the incidence of post ERCP pancreatitis in high risk patients. Inadvertent or intentional pancreatic duct cannulation can facilitate biliary cannulation and allow placement of a pancreatic stent to reduce risk. Pancreatoscopy is now feasible, but its utility and safety are not well established. Understanding risks and benefits of diagnostic and interventional aspects is essential, as well as proper training for the level of procedure performed.