hepatic and biliary disorders
Imaging Tests of the Liver and Gallbladder
Endoscopic retrograde cholangiopancreatography (ERCP)
 Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy through the second portion of the duodenum with contrast imaging of the biliary and pancreatic ducts. The papilla of Vater is cannulated through an endoscope placed in the descending duodenum, and the pancreatic and biliary ducts are then injected with a contrast agent. ERCP provides detailed images of much of the upper gastrointestinal tract and the periampullary area, biliary tract, and pancreas. ERCP can also be used to obtain tissue for biopsy. ERCP is the best test for diagnosis of ampullary cancers. ERCP is as accurate as endoscopic ultrasonography for diagnosis of common duct stones. Because it is invasive, ERCP is used more for treatment (including simultaneous diagnosis and treatment) than for diagnosis alone. ERCP is the procedure of choice for treating biliary and pancreatic obstructing lesions, and for Choledocholithiasis and Cholangitis None Stenting of strictures (inflammatory or malignant) Sphincterotomy (eg, for papillary stenosis, also called sphincter of Oddi dysfunction) Morbidity from a diagnostic ERCP with only injection of contrast material is about 1%. Adding sphincterotomy raises morbidity to 4 to 9% (mainly related to Overview of Pancreatitis and bleeding). ERCP with manometry to measure sphincter of Oddi pressure causes pancreatitis in up to 25% of patients. 