Endoscopic retrograde cholangiopancreatography (ERCP)

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Doubilet and Mulholland1 were the first to demonstrate the use of operative pancreatography in 1951. This was followed by other reports,2–4 and not all of them recommended the procedure as safe or useful.5 In 1965 Rabinov and Simon6 succeeded in nonendoscopic, nonoperative cannulation of the ampulla of Vater under fluoroscopic guidance. This method did not receive much further attention because of the report of Mc-Cune et al7 in 1968. They have the distinction of having performed the first endoscopic ampullary cannulation and pancreatography. Large series were subsequently reported from Japan,8, 9 most notably by Oi.10, 11

Roentgenographically, the normal and abnormal features of the biliary system are relatively familiar. However, criteria for the differential diagnosis of pancreatic disease by roentgenography are now emerging as a result of endoscopic retrograde pancreatography.12–15 The severity of histologic changes in chronic pancreatitis has been shown to correlate well with the extent of changes demonstrated in the pancreatic ductal system.16, 17 Other studies have highlighted the singular value of retrograde cholangiography when jaundice prevents visualization of the biliary ducts via the intravenous method.18, 19 The complication rate for the endoscopic method will prove to be less than the 5% quoted for transhepatic cholangiography,20, 21 and the success rate of diagnosis will undoubtedly prove to be greater than the 74% given for the transhepatic method.21 While some investigators22, 23 have urged caution in the further development of these procedures because of time requirements and expense, there can be little doubt that endoscopic retrograde cholangiopancreatography. . .



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