ASGE Masterclass: Endoscopic Retrograde Cholangiopancreatography (ERCP) Virtual | January 2022-5_Faulx ERCP cannulation ASGE masterclassFINAL (1).pdf

5_Faulx ERCP cannulation ASGE masterclassFINAL (1).pdf

Pdf Summary

This document summarizes various methods and techniques for successful biliary and pancreatic cannulation during endoscopic retrograde cholangiopancreatography (ERCP) procedures. It discusses the anatomy, positioning, and tools involved in cannulation. The use of wire-guided cannulation is explored, with mixed data on its effectiveness. Complications and risk factors for post-ERCP pancreatitis (PEP) are identified, including precut sphincterotomy and pancreatic injection. The document suggests minimizing complications through appropriate patient selection, risk stratification, and prophylactic measures such as pancreatic stenting, rectal NSAIDs, and aggressive IV fluid administration. The advantages and disadvantages of pancreatic duct stenting are discussed, along with pharmacotherapy options, particularly rectal indomethacin, in preventing PEP. The document also emphasizes the importance of being well-versed in various cannulation techniques, being proficient in needle knife use, and staying up-to-date through resources like VideoGIE. The document concludes by recommending the consideration of indomethacin for all ERCP patients and the use of lactated Ringer's solution for hydration before and after the procedure, depending on the patient's risk factors.

Keywords

biliary cannulation

pancreatic cannulation

ERCP procedures

wire-guided cannulation

post-ERCP pancreatitis

pancreatic stenting

rectal indomethacin

cannulation techniques

needle knife use

VideoGIE