Role of endoscopic retrograde cholangiopancreatography in acute pancreatitis

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a useful tool in the evaluation and management of acute pancreatitis. This review will focus on the role of ERCP in specific causes of acute pancreatitis, including microlithiasis and gallstone disease, pancreas divisum, Sphincter of Oddi dysfunction, tumors of the pancreaticobiliary tract, pancreatic pseudocysts, and pancreatic duct injury. Indications for endoscopic techniques such as biliary and pancreatic sphincterotomy, stenting, stricture dilation, treatment of duct leaks, drainage of fluid collections and stone extraction will also be discussed in this review. With the advent of less invasive and safer diagnostic modalities including endoscopic ultrasound (EUS) and magnetic retrograde cholangiopancreatography (MRCP), ERCP is appropriately becoming a therapeutic rather than diagnostic tool in the management of acute pancreatitis and its complications.

Figure 1

A: Pancreas divisum with filling of the small ventral duct; B: Pancreas divisum with filling of dorsal duct through the minor orifice.

Figure 2

A: Sphicterotome performing minor ampulla sphincter-otomy; B: Guidewire in place after minor sphincterotomy; C: Pancreatic stent placement post-sphincterotomy for pancreas divisum.

Figure 3

Various designs of pancreatic stents (with permission from Cook Endoscopy).

Figure 4

Classic “fish eye” appearance of IPMT with mucin draining from minor ampulla.