ERCP
Formal Definition
Endoscopic Retrograde Cholangiopancreatography; a combined endoscopic and fluoroscopic procedure used to diagnose and treat conditions of the bile ducts and pancreatic duct, including choledocholithiasis (common bile duct stones), biliary strictures, and cholangitis; performed under conscious sedation or general anesthesia by advanced endoscopists.
How It's Used on the Ward
"They need an ERCP" or "ERCP for the stone in the duct" — the definitive procedure to clear CBD stones or stent a blocked bile duct.
Example
""70-year-old with RUQ pain, fever, jaundice, and a dilated CBD with stone on MRCP — Charcot triad for cholangitis. IV fluids and antibiotics, urgent ERCP tonight for biliary decompression.""
Clinical Context
Indications: choledocholithiasis, acute cholangitis (urgent/emergent), biliary pancreatitis with persistent obstruction, malignant biliary obstruction (stenting), bile leak post-surgery. Complications: pancreatitis (most common, 3–5%), perforation, bleeding, cholangitis, contrast reaction. Post-ERCP pancreatitis risk reduced by rectal indomethacin prophylaxis (now standard). Charcot triad (RUQ pain + fever + jaundice) suggests cholangitis; Reynolds pentad adds AMS + hypotension (septic shock — true emergency). MRCP (MRI) is the non-invasive diagnostic first step when CBD stone suspected; ERCP is reserved for therapeutic intervention.