ERCP Bootcamp for the Endoscopy Team (On-demand) | December 2023-ASGE and other ERCP Guidelines

Video Transcription

Video Summary

Dr. Dennis Chen discusses guidelines for ERCP (endoscopic retrograde cholangiopancreatography) procedures. He reviews the existing guidelines from the American Society for Gastrointestinal Endoscopy (ASGE) and other societies, focusing on cannulation and sphincterotomy techniques, as well as the appropriate utilization of ERCP for conditions such as cholangitis and post-liver transplant anastomotic strictures. The ASGE recommends that ERCP should be performed by experienced operators who have completed at least 200 supervised procedures, with 80 of those involving independent sphincterotomies or native papilla cases. The guidelines recommend guidewire-assisted cannulation to reduce the risk of post-ERCP pancreatitis. For sphincterotomy techniques, mixed current is recommended due to decreased bleeding risk. ERCP is suggested over percutaneous transhepatic biliary drainage (PTBD) for cholangitis management. The guidelines also recommend ERCP within 48 hours of presentation for cholangitis cases. For post-liver transplant anastomotic strictures, ERCP is suggested over PTBD, and covered metal stents are recommended over multiple plastic stents for initial therapy. The guidelines also suggest MRCP (magnetic resonance cholangiopancreatography) as the diagnostic test of choice for suspected post-liver transplant strictures. Periprocedural antibiotics are suggested for patients undergoing elective ERCP in whom complete biliary drainage is challenging to achieve.

Asset Subtitle

Dennis Chen, MD

Keywords

ERCP guidelines

cannulation techniques

sphincterotomy techniques

cholangitis management

post-liver transplant anastomotic strictures

MRCP