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Endoscopy 2004; 36(2): 137-146
DOI: 10.1055/s-2004-814181
State of the Art Review
© Georg Thieme Verlag Stuttgart · New York

Diagnostic Endoscopic Retrograde Cholangiopancreatography

M.  Ciocirlan1 , T.  Ponchon1
  • 1Dept. of Digestive Diseases, Edouard Herriot Hospital, Lyon, France
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Publication History

Publication Date:
06 February 2004 (online)

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Introduction

The United States National Institutes of Health (NIH) State of the Science Conference Statement, published in 2002 [1], reviewed the current indications and future directions for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In biliary stone disease, magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) have replaced purely diagnostic ERCP. In cases of advanced pancreatic malignancy in which chemoradiotherapy is indicated, ERCP may be one of the modalities for tissue sampling by needle aspiration, brush cytology, or forceps biopsy, alone or in combination with other techniques. ERCP is the best method of diagnosis for ampullary malignancies. It is also useful for diagnosing biliary malignancy in patients with underlying sclerosing cholangitis. Purely diagnostic ERCP has no role in acute or chronic pancreatitis. In recurrent pancreatitis of unknown cause, ERCP with sphincter manometry should be used if MRCP or computed tomography (CT) are negative, or should be used without manometry if pancreas divisum is suspected. Purely diagnostic ERCP has no role in the diagnosis of abdominal pain of possible pancreatic or biliary origin. This NIH statement, which is open to discussion, illustrates the way in which the role of diagnostic ERCP is becoming increasingly limited due to the emergence of noninvasive techniques such as MRCP and EUS.

The present review discusses the literature on diagnostic ERCP published from July 2002, the latest date covered in the previous review by Schöfl and Haefner [2], to August 2003.

References

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T. Ponchon, M.D.

Dept. of Digestive Diseases · Hôpital Edouard Herriot

Place d’Arsonval · 69437 Lyon
Cedex 03 · France

Fax: +33-4-72 11 01 47

Email: thierry.ponchon@chu-lyon.fr

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