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

11_ERCP and EUS - Shiels

Pdf Summary

ERCP and EUS are both important procedures for the diagnosis and management of GI and non-GI diseases. ERCP, or endoscopic retrograde cholangiopancreatography, has evolved from a diagnostic to a therapeutic procedure. It is indicated for choledocholithiasis with or without cholangitis, malignant biliary obstruction, bile leak after cholecystectomy, biliary strictures, chronic pancreatitis, and pancreatic duct injury. For high-risk cases, ERCP should be done directly, while for lower-risk cases, MRCP, EUS, or lap cholecystectomy with intraoperative cholangiogram can be considered.<br /><br />Preprocedural assessment for ERCP involves reviewing the patient's risk assessment and making decisions on sedation and antibiotic use. Management of anticoagulation depends on the risk involved in the specific ERCP procedure. Informed consent should be obtained, and postprocedure management includes monitoring for clinical response, clearing liquids when recovered from anesthesia, and arranging appropriate follow-up.<br /><br />EUS, or endoscopic ultrasound, combines endoscopy with high-frequency ultrasonography and is used for diagnosis, staging, and management of various diseases. Indications for EUS include the diagnosis of pancreatic cystic/solid lesions, subepithelial lesions, mediastinal mass/adenopathy, liver mass, thickened gastric folds, and choledocholithiasis. It is also helpful for staging cancers in the esophagus, stomach, pancreas, lung, ampulla, and rectum. Therapeutically, EUS can be used for pseudocyst drainage, bile duct/gallbladder drainage, celiac plexus block, glue or coil embolization of varices, and EUS-guided ERCP. Similar to ERCP, preprocedural assessment, management of anticoagulation, and informed consent are important for EUS.<br /><br />In summary, proper patient selection is crucial in performing ERCP and EUS. Less invasive and risky tests should be chosen whenever possible. Management of anticoagulation and operative risk must be taken into consideration. Lastly, early recognition and management of complications are essential for successful outcomes.

Keywords

ERCP

EUS

diagnosis

management

choledocholithiasis

biliary obstruction

pancreatic duct injury

anticoagulation

informed consent

complications