ERCP / MRCP

ERCP (Endoscopic Retrograde Cholangio Pancreatography) An ERCP is used if there is evidence of blockage of the bile duct, (they would use a CT scan prior to an ERCP), Used for people with unexplained jaundice, or unexplained abnormalities of liver chemistries. or those being considered for a liver transplant.

If I did not have pancreatitis, I would not allow an ERCP as a diagnostic test. One of the major complications of ERCP is developing pancreatitis – particularly if you already have pain. Post-ERCP pancreatitis occurred in 27.2% of those who previously had pain. Without pain, the risk is 7.2%. ERCP is an invasive procedure with other complications. There are links below that describe these complications.

There is a non-invasive alternate to ERCP – MRCP (Magnetic resonance cholangiopancreatography) MRCP is the technique that through use of magnetic resonance imaging. visualises the intra- and extrahepatic bile ducts and the pancreatic duct. The technique has improved since its first use in 1991. Today, MRCP is almost comparable to endoscopic retrograde cholangiopancreatography (ERCP). Compared with ERCP, MRCP has the advantage of adding a 3D imaging and fast multiple imaging planes capability. MRCP has negligible morbidity and mortality.

MRCP is strictly for diagnostic purposes, it has no therapeutic role (ie. placing stents, etc.).

Resources:
ASGE - ERCP risks and complications
Post-ERCP risks and complications
Post-ERCP risks and complications
Realistic risks higher than patient told
MRCP, an alternative to ERCP
Florida, ERCP Malpractice Info.
MRCP description, compared to ERCP

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