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

11_ERCP and EUS - Shiels
Pdf Summary
ERCP (endoscopic retrograde cholangiopancreatography) and EUS (endoscopic ultrasound) are both important procedures for diagnosing and managing gastrointestinal (GI) and non-GI diseases. However, less risky alternatives such as EUS, MRCP, US, CT, and intraoperative cholangiogram have replaced diagnostic ERCP. <br /><br />ERCP is primarily indicated for conditions such as choledocholithiasis (gallstones in the bile duct) with or without cholangitis (infection of the bile duct), malignant biliary obstruction, postcholecystectomy bile leak, biliary stricture (narrowing), chronic pancreatitis, and pancreatic duct injury/leak. High-risk patients with CBD stones or ascending cholangitis usually proceed directly to ERCP, while lower-risk patients may undergo MRCP, EUS, or laparoscopic cholecystectomy with intraoperative cholangiogram. Preprocedural assessment involves reviewing the patient's risk classification, deciding on sedation, and considering the need for antibiotics or rectal indomethacin to reduce the risk of post-procedure pancreatitis.<br /><br />EUS combines endoscopy with high-frequency ultrasonography and is used for the diagnosis, staging, and management of various GI and non-GI conditions. Key indications for EUS include pancreatic cystic or solid lesions, subepithelial lesions, mediastinal masses or adenopathy, liver masses, thickened gastric folds, bile duct dilation, and choledocholithiasis. EUS can also be used for staging esophageal, gastric, pancreatic, lung, ampullary, and rectal cancers. Preprocedural management includes assessing the patient's risk, deciding on sedation, managing anticoagulation, prescribing antibiotics (if necessary), and obtaining informed consent.<br /><br />Both ERCP and EUS have potential risks and complications, such as pancreatitis, perforation, bleeding, and cardiopulmonary issues. Postprocedure management involves gradually reintroducing clear liquids, advancing the diet, monitoring for a clinical response, and arranging appropriate follow-up care.<br /><br />In summary, ERCP and EUS are valuable procedures for diagnosing and managing GI and non-GI diseases. Patient selection and risk assessment are crucial, and less invasive tests should be chosen whenever possible. Proper management of anticoagulation and operative risk is essential, and prompt recognition and management of complications are important.
Keywords
ERCP
EUS
diagnosing
managing
choledocholithiasis
biliary stricture
pancreatic duct injury
high-frequency ultrasonography
staging
complications