ERCP CASES WORTH PURSUING

1 – INDICATION FOR THE PROCEDURE: As there are significant possible complications for this procedure, a clear indication is necessary to justify the procedure and any subsequent complications.

INDICATIONS INCLUDE:

a. Abnormal liver function tests with dilated common bile duct

b. Gallstones and pancreatitis

c. Positive magnetic resonance cholangio-pancreatogram for a biliary stone

d. Mass in the head of the pancreas on another study

e. Jaundice due to obstruction.

THE FOLLOWING ARE NOT ADEQUATE

INDICATIONS:

a. Chronic abdominal pain or right upper quadrant pain without any objective evidence of obstruction (i.e. Abnormal LFTs or duct dilatation)

b. Jaundice without evidence of obstruction

c. Chronic pancreatitis (not of gallstone origin)

d. Nausea of unexplained etiology.

2 – UNRECOGNIZED OR UNTREATED COMPLICATIONS:

a. Pancreatitis ocurs in 3-15% of ERCP cases. It is evident within a few hours of the procedure. The failure to diagnose and treat this could result in death.

b. Bleeding from a sphincterotomy occurs in about 1 in 1000, failure to treat could result in multiple complications

c. Perforation ocurs in about 1 in 1000, failure to recognize and treat could lead to peritonitis, pancreatits, abscess formation and death.

3 – UNUSUAL COMPLICATIONS OFTEN INDICATIVE OF

NEGLIGENT TECHNIQUE:

a. Esophageal perforation

b. Hepatic hematoma

4 – INFORMED CONSENT: The following complications need to be fully discussed and explained:

a. Severe pancreatitis

b. Bleeding

c. Perforation