ASGE Annual GI Advanced Practice Provider Course - Day Two | July 2021-17_ERCP EUS Basics

17_ERCP EUS Basics - Shiels
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ERCP (Endoscopic Retrograde Cholangiopancreatography) and EUS (Endoscopic Ultrasound) are two important procedures used for the diagnosis and management of pancreatic and biliary diseases. While ERCP has evolved from a diagnostic to a therapeutic procedure, other less risky procedures such as EUS, MRCP, US, CT, and intraoperative cholangiogram have replaced the diagnostic use of ERCP.<br /><br />ERCP is indicated for various conditions such as choledocholithiasis, malignant biliary obstruction, postcholecystectomy bile leak, biliary stricture, chronic pancreatitis, and pancreatic duct injury. High-risk patients with choledocholithiasis or ascending cholangitis should proceed directly to ERCP, while lower-risk patients may undergo MRCP, EUS, or laparoscopic cholecystectomy with intraoperative cholangiogram.<br /><br />Preprocedural assessment for ERCP involves reviewing the patient's risk assessment and making decisions about sedation and antibiotics. Management of anticoagulation is also important, with sphincterotomy and dilation considered high risk and requiring the temporary discontinuation of anticoagulation. Informed consent for ERCP includes a discussion of the procedure, goals, personnel involved, and the risks of complications such as pancreatitis, perforation, bleeding, cardiopulmonary issues, and death.<br /><br />EUS, on the other hand, is a technique used for the diagnosis, staging, and management of a wide range of gastrointestinal and non-gastrointestinal diseases. It combines endoscopy with high-frequency ultrasonography. The number of EUS cases has been steadily increasing.<br /><br />EUS indications include diagnostic evaluation of various conditions such as pancreatic cystic/solid lesions, subepithelial lesions, liver mass, bile duct dilation, and choledocholithiasis. It is also used for staging esophageal, gastric, pancreatic, lung, ampullary, and rectal cancers. Therapeutic applications of EUS include pseudocyst drainage, bile duct/gallbladder drainage, celiac plexus block, glue or coil embolization of varices, and EUS-guided ERCP.<br /><br />Preprocedural assessment, management of anticoagulation, and informed consent are also important considerations for EUS. Complications of EUS include pancreatitis, perforation, bleeding, cardiopulmonary issues, and death.<br /><br />In summary, ERCP and EUS are essential procedures for the diagnosis and management of gastrointestinal and non-gastrointestinal diseases. Appropriate patient selection, consideration of less invasive/risky tests when possible, and the management of anticoagulation and operative risks are key. Early recognition and management of complications are essential.
Keywords
ERCP
EUS
pancreatic diseases
biliary diseases
choledocholithiasis
MRCP
sedation
complications
diagnostic evaluation
therapeutic applications