Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic technique in
which a specialized side-viewing endoscope is guided into the duodenum, allowing for
instruments to access the biliary and pancreatic ducts. ERCP was initially developed
as a diagnostic tool as computed tomography was in its infancy during that time. ERCP
has evolved since its inception in the 1960s to becoming not only a valuable diagnostic
resource but now an effective therapeutic intervention in the treatment of various
biliary disorders. The most common biliary interventions performed by ERCP include
the management of biliary obstructions for benign and malignant indications. Additionally,
endoscopic ultrasound (EUS) has been increasingly utilized in diagnosing and intervening
on pancreaticobiliary lesion. This article will discuss the various methods currently
available for various endoscopic biliary interventions and future interventional techniques.
For the management of biliary strictures, EUS can be utilized with fine need aspiration,
while ERCP can be used for the placement of various stents and diagnostic modalities.
Another example is radiofrequency ablation, which can be used for the treatment of
hilar strictures. Achieving bile duct access can be challenging in patients with complicated
clinical scenarios; other techniques that can be used for bile duct access include
EUS-guided rendezvous approach, transluminal approach, Choleodochoduodenostomy, and
hepatogastrostomy, along with gaining access in complicated anatomy such as in patients
with Rou-en-Y anatomy. Another useful endoscopic tool is nonsurgical drainage of the
gallbladder, which can be a suitable option when patients are not optimal surgical
candidates. There has also been an increase in outpatient utilization of ERCP, which
was previously seen as a predominantly inpatient procedure in the past. Possible future
evolutions of biliary interventions include robotic manipulation of a duodenoscope
and direct infusion of chemotherapeutic or immunomodulatory agents into the pancreaticobiliary
tree. These advancements will depend on parallel advancements in other imaging and
laboratory as well as breakthrough technology or techniques by other disciplines including
interventional radiology and minimally invasive surgery.
Keywords
endoscopic biliary interventions - advanced endoscopy - gastroenterology
