KADA DA A KADA NE ERCP Prof dr

KADA DA, A KADA NE ERCP Prof. dr. sc. Žarko Babić KB Dubrava, Zagreb Klinika za unutarnje bolesti Zavod za gastroenterologiju Odjel za gastroenterologiju

Indications l l l l 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

Indications l Suspected primary sclerosing cholangitis (PSC) l Evaluation of abnormal biliary system findings from a CT, EUS or MRCP l Obstructive jaundice l Dilated CBD (common bile duct) l Tissue sampling

Indications l l l 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-conclusion TODAY: Therapeutic ERCP l 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) l

Contraindications l l l MAJOR: The risk of sedation GENERAL: Recent myocardial infarction Visceral perforation, Risk of perforation – (some duodenal diverticula, anatomyc abnormalities) l l l 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 !)