ASGE Annual GI Advanced Practice Provider Course - Day Two (On-Demand)

17_ERCP EUS Basics - Shiels
Pdf Summary
Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are important procedures for diagnosing and managing pancreatic and biliary diseases. ERCP has evolved from a diagnostic to a therapeutic procedure, but other less risky procedures have replaced it for diagnostic purposes, such as EUS, magnetic resonance cholangiopancreatography (MRCP), ultrasound (US), computed tomography (CT), and intraoperative cholangiogram.<br /><br />ERCP is indicated for choledocholithiasis, malignant biliary obstruction, postcholecystectomy bile leak, biliary stricture, chronic pancreatitis, and pancreatic duct injury/leak. High-risk patients with a CBD stone 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 includes reviewing the patient's risk assessment and making a decision on the sedation plan. Antibiotics are only necessary in patients with primary sclerosing cholangitis or inadequate biliary drainage. Rectal indomethacin may be given to high-risk patients to decrease the risk of post-procedure pancreatitis.<br /><br />Anticoagulation management varies depending on the procedure. For sphincterotomy and dilation, anticoagulation and antiplatelet agents should be held. Stent placement/removal, brushings, cholangiogram, and pancreatogram are considered low-risk and may be performed on anticoagulation or antiplatelet agents.<br /><br />Informed consent for ERCP should include a review of the procedure, goals, personnel, alternatives, and the risk of complications, such as pancreatitis, perforation, bleeding, cardiopulmonary issues, and death.<br /><br />Postprocedure management involves starting clear liquids when the patient has recovered from anesthesia, advancing the diet the following day, monitoring for clinical response, and arranging appropriate follow-up, such as surgical evaluation or repeat ERCP for stent removal/replacement.<br /><br />EUS combines endoscopy with high-frequency ultrasonography and is used for diagnosing, staging, and managing a wide range of GI and non-GI diseases. The number of EUS cases has steadily increased. Preprocedural assessment, management of anticoagulation, and informed consent for EUS are similar to those for ERCP.<br /><br />In summary, ERCP and EUS are essential procedures for managing GI and non-GI diseases. Patient selection, choosing less invasive/risky tests when possible, and careful management of anticoagulation and operative risk are important. Early recognition and management of complications are essential.
Keywords
ERCP
EUS
pancreatic diseases
biliary diseases
choledocholithiasis
laparoscopic cholecystectomy
anticoagulation management
informed consent
complications
postprocedure management