ERCP Bootcamp for the Endoscopy Team (Live and Virtual) | December 2023-Role of ERCP in the management of malignant hilar strictures

Video Transcription

Video Summary

ERCP (Endoscopic Retrograde Cholangiopancreatography) is a procedure used to diagnose and treat conditions affecting the biliary and pancreatic systems. In cases where there is a proximal bile duct stricture, the procedure becomes more complex and time-consuming. The distal common bile duct is easier to manage compared to the proximal common bile duct, which requires better skills in catheter navigation, wire manipulation, and selective access. Proximal strictures pose more risks, especially for cholangitis.<br /><br />In cases of proximal biliary strictures, it is necessary to delineate the biliary anatomy and obtain tissue for diagnosing malignancy. However, proximal cases have a lower chance of obtaining a diagnosis compared to distal cases, requiring repeated procedures to get an accurate diagnosis. Selective access and drainage of the affected ducts is necessary, while also trying to avoid causing cholangitis.<br /><br />Proximal strictures are often associated with primary sclerosing cholangitis (PSC), a chronic inflammatory disease of the biliary tree. PSC is strongly linked to cholangiocarcinoma and indicates a higher risk for gallbladder cancer and hepatocellular cancer. Different tests, such as brushings, biopsies, FISH (fluorescent in situ hybridization), and MRI scans, can be used to aid in diagnosis.<br /><br />Overall, proximal ERCP cases require more expertise and skill due to the complexity of the procedure and the higher risks involved.

Asset Subtitle

Douglas G. Adler, MD, FASGE

Keywords

ERCP

biliary system

proximal bile duct stricture

cholangitis

malignancy diagnosis

selective access

PSC