KADA DA, A KADA NE ERCPKADA DA, A KADA NE ERCP

Prof.dr.sc.Žarko Babić

KB Dubrava, Zagreb

Klinika za unutarnje bolesti

Zavod za gastroenterologiju

Odjel za gastroenterologiju

IndicationsIndications

Evaluation of chronic pancreatitis Recurrent cholangitis Evaluation of possible cancer of the biliary tree

and/or pancreas Choledocholithiasis (ductal stones) Removal of retained bile or pancreatic stones Pre- or post-operative cholecystectomy when

ductal stones are suspected Chronic or acute abdominal pain when bile duct

disease is suspected

IndicationsIndications

Suspected primary sclerosing cholangitis (PSC)

Evaluation of abnormal biliary system findings from a CT, EUS or MRCP

Obstructive jaundice Dilated CBD (common bile duct) Tissue sampling

IndicationsIndications

Biliary strictures Sphincter of Oddi dysfunction Palliative or pre-operative stenting of

malignant biliary or pancreatic strictures Treatment of bile leaks (biliary ducts or

pancratic duct) Pancreatic fluid colections (pseudocysts and

necrosis-that communicate with pancreatic duct)

Indications-conclusionIndications-conclusion

TODAY: Therapeutic ERCP Always is indicated in:

-Conditions that need immidiate attention and resolution (diagnostic, therapeutic-papilotomy, dilatation, drainage, stenting, ampulectomy etc.)

-Bile duct (pancreatic duct) dilatation with laboratory signs of cholestasis (bilirubin, GGT, ALP)

ContraindicationsContraindications MAJOR: The risk of sedation GENERAL: Recent myocardial infarction Visceral perforation, Risk of perforation

– (some duodenal diverticula, anatomyc abnormalities) Recent barium enema-superposition Who cannot cooperate RELATIVE: 1) Patient’s needs vrs. Patient’s current condition (eg.:

may be unstabile due to an infection that is resolved with procedure-biliary sepsis)

2) Coagulopathy (correction !)