# Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography

This technique is now used only as a therapeutic modality in patients with obstructive jaundice; USG and MRCP have taken over the diagnostic aspect. Using a side-viewing endoscope the ampulla of  Vater is identified and cannulated. Injection of  water-soluble contrast into the bile duct provides excellent images of the ductal anatomy ( Figure 71.13 ) and can identify causes of obstruction such as calculi ( Figure 71.14 ) and malig nant strictures ( Figure 71.15 ). Bile aspirates can be obtained and sent for cytological and microbiological examination and brushings can be taken from strictures for cytology . T herapeu tic interventions such as stone removal or stent placement to relieve obstruction can be performed simultaneously . Cholangioscopy is a relatively new technique in which a thin scope is inserted through the channel of  an ER CP scope to visually inspect the bile duct. The main indications include indeterminate or unexplained biliary strictures , nodules or masses and crushing di ffi cult-to-remove bile duct stones with lithotripsy . - - 

Figure 71.13
Endoscopic retrograde cholangiopancreatography:
normal cholangiogram.
-
Figure 71.14
Endoscopic retrograde cholangiopancreatography:
common duct obstruction due to stone (courtesy Dr Amit Maydeo,
Mumbai, India).
Figure 71.15
Endoscopic retrograde cholangiopancreatography:
partial occlusion of bile duct by malignant stricture (arrow).



Figure 71.16
Transhepatic cholangiogram showing stricture of com
mon hepatic duct (courtesy of Ms Phyllis George, FRCS, London, UK).