Endoscopic Retrograde Pancreatography

Since its introduction in 1968,¹ endoscopic retrograde cholangiopancreatography (ERCP) has become an integral part of gastroenterological practice. During ERCP, a side-viewing endoscope is passed through the mouth to the duodenum, the papilla is identified and cannulated, and radiographic contrast material is injected into the bile duct and/or pancreatic duct under fluoroscopic guidance. Like biliary endoscopy, endoscopic retrograde pancreatography (ERP) has evolved from being only a diagnostic procedure to frequently a therapeutic one, providing patients with a minimally invasive method to treat selected pancreatic diseases that previously required open surgery. However, fear of complications, particularly pancreatitis, has prevented some endoscopists from applying techniques used in therapeutic cholangiography for treatment of pancreatic disorders.² Therefore, ERP with associated therapy is mostly performed in expert centers. In this review, we will focus on the normal and abnormal pancreatic ductal anatomy, indications for ERP, and techniques to optimize the acquisition and interpretation of pancreatographic images. Discussion of pancreatic endotherapy and its complications is beyond the scope of this review.

Abbreviations used in this paper: CT, computed tomography, ERCP, endoscopic retrograde cholangionpancreatography, ERP, endoscopic retrograde pancreatography, EUS, endoscopic ultrasound, IPMN, intraductal papillary mucinous neoplasm, LOCM, low osmolality contrast media, MRCP, magnetic resonance cholangiopancreatography, MRI, magnetic resonance imaging