KADA DA, A KADA NE ERCP

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KADA DA, A KADA NE ERCP

• Prof.dr.sc.Žarko Babic
• KB Dubrava, Zagreb
• Klinika za unutarnje bolesti
• Zavod za gastroenterologiju
• Odjel za gastroenterologiju

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Indications

• Evaluation of chronic pancreatitis
• Recurrent cholangitis
• Evaluation of possible cancer of the biliary tree
  and/or pancreas
• Choledocholithiasis (ductal stones)
• Removal of retained bile or pancreatic stones
• Pre- or post-operative cholecystectomy when
  ductal stones are suspected
• Chronic or acute abdominal pain when bile duct
  disease is suspected

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Indications

• Suspected primary sclerosing cholangitis (PSC)
• Evaluation of abnormal biliary system findings
  from a CT, EUS or MRCP
• Obstructive jaundice
• Dilated CBD (common bile duct)
• Tissue sampling

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Indications

• Biliary strictures
• Sphincter of Oddi dysfunction
• Palliative or pre-operative stenting of malignant
  biliary or pancreatic strictures
• Treatment of bile leaks (biliary ducts or
  pancratic duct)
• Pancreatic fluid colections (pseudocysts and
  necrosis-that communicate with pancreatic duct)

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Indications-conclusion

• TODAY Therapeutic ERCP
• Always is indicated in
• -Conditions that need immidiate attention and
  resolution (diagnostic, therapeutic-papilotomy,
  dilatation, drainage, stenting, ampulectomy etc.)
• -Bile duct (pancreatic duct) dilatation with
  laboratory signs of cholestasis (?bilirubin, GGT,
  ALP)

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Contraindications

• MAJOR
• The risk of sedation
• GENERAL
• Recent myocardial infarction
• Visceral perforation, Risk of perforation
• (some duodenal diverticula, anatomyc
  abnormalities)
• Recent barium enema-superposition
• Who cannot cooperate
• RELATIVE
• 1) Patients needs vrs. Patients current
  condition (eg. may be unstabile due to an
  infection that is resolved with procedure-biliary
  sepsis)
• 2) Coagulopathy (correction !)