The use of plastic pancreaticobiliary stents for drainage of the bile duct was described more than 3 decades ago. These stents are used for a variety of indications, including malignant and benign conditions, and have proven reliable and safe for…
Pancreas divisum (literally “divided pancreas”) is a congenital anatomic variant in which the dorsal and ventral pancreatic ducts completely or partially fail to fuse, and drain separately into the medial wall of the duodenum. Thus in most patients with pancreas…
Since its initial application in 1974, endoscopic biliary sphincterotomy (see Chapter 17 ) has revolutionized the approach to patients with biliary tract diseases. Biliary sphincterotomy has been used in conjunction with other techniques such as stent placement, balloon and basket…
Introduction and Scientific Basis Biliary stone disease is the most common reason for undertaking therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In Western countries, choledocholithiasis is primarily related to passage of gallstones from the gallbladder into the common bile duct. The clinical…
Endoscopic sphincterotomy (EST; see Chapter 17 ) has become the procedure of choice for removal of stones from the bile duct, especially in postcholecystectomy patients. The procedure is successful in 90% to 98% of patients, and 86% to 91% of…
Diagnostic endoscopic retrograde cholangiopancreatography (ERCP) has been widely replaced by computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and endoscopic ultrasonography (EUS) as noninvasive or less invasive imaging techniques. Indications for diagnostic ERCP should be limited to selected patients with indeterminate…
The sphincter of Oddi (SO) is a complex smooth muscle structure surrounding the terminal common bile duct, main pancreatic duct, and the common channel, when present ( Fig. 16.1 ). The high-pressure zone generated by the sphincter ranges from 4…
The first and often most important step in endoscopic retrograde cholangiopancreatography (ERCP) is successful deep cannulation of the desired duct, most commonly the common bile duct (CBD). Although it remains the first step, cannulation of the CBD can be challenging…
Despite advances in imaging and device technology over the past decade, endoscopic retrograde cholangiopancreatography (ERCP) continues to be technically challenging and subject to adverse events and procedure failure. To some extent this is accounted for by the knowledge that among…
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most dangerous procedures that gastroenterologists perform regularly; adverse events occur in at least 5% of cases, and lawsuits are common. However, the likelihood of being sued (as well as the success of…