Endoscopic Retrograde Pancreatography ERCP

In acute pancreatitis, ERCP is used in recurrent episodes without an identifiable cause. It has identified the cause in about 50% of such patients.1 ERCP is usually performed after the symptoms have resolved. Some expected findings include pancreas divisum, stenosis of the ampula of Vater, and in some cases focal pancreatic ductal stenosis.7 There is no role for ERCP in the initial onset of acute pancreatitis.

In chronic pancreatitis ERCP can demonstrate ductal abnormalities such as dilations, strictures, and pseudocysts which cannot otherwise be visualized. The classic chain of lakes appearance, with alternating dilation and stricture is the most classic finding of chronic pancreatitis but is less common that ductal dilation alone. Chronic pancreatitis can be safely excluded with a normal ERCP.7

ERCP also provides the opportunity to intervene with stenting, sphincterotomy, and stone extraction procedures to allow for drainage of the pancreas. This can provide dramatic pain relief to the patient with acute pancreatitis. However, long term data on pain relief for patients with chronic pancreatitis is not yet available. Stents, however, are used as temporizing measures with possible surgical intervention still in sight. Complications from these procedures are exacerbation of pancreatitis, stent migration, stent breakage, stent occlusion, and pancreatic ductal changes.

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