Masterclass: EndoQuest - Endoscopy in the GI Unit (On-demand) | September 2025-ERCP Made Easy: Mastering Tools and Techniques for Success

Video Transcription

Video Summary

This comprehensive discussion focuses on ERCP (Endoscopic Retrograde Cholangiopancreatography), a complex endoscopic procedure used mainly for therapeutic intervention within the biliary and pancreatic ducts. ERCP involves accessing the bile duct in a retrograde manner—going against the natural bile flow from the intestine to the liver—through the ampulla in the duodenum. The procedure is challenging because delicate tools must be manipulated remotely via a long scope, requiring precision without direct visibility inside the ducts, relying on fluoroscopic imaging.<br /><br />Key considerations include understanding when ERCP is indicated—commonly for bile duct stones, strictures, blockages, or to assist surgical cases—and when alternative diagnostic methods (like MRI or EUS) may be safer or more appropriate. Preparation involves patient consent, anesthesia planning, anticoagulant assessment, and ensuring access to appropriate tools and radiation safety measures.<br /><br />The procedure steps include cannulation (inserting a guidewire into the correct duct), contrast injection to visualize structures via fluoroscopy, sphincterotomy (cutting the sphincter muscle using electrocautery to aid access), device exchange over the guidewire, and performing therapeutic tasks such as stone removal, stricture evaluation, and stent placement. Stent selection (plastic vs. metal) depends on clinical context and long-term needs.<br /><br />Successful ERCP demands teamwork, careful organization, proper equipment handling—keeping wires lubricated and untangled—and vigilance during all phases. The presentation emphasizes the need for mental imaging of anatomy, communication, and patience to safely and effectively perform this intricate procedure.

Asset Subtitle

Dr. Kalpesh Patel

Keywords

ERCP

Endoscopic Retrograde Cholangiopancreatography

bile duct stones

sphincterotomy

fluoroscopic imaging

biliary strictures

stent placement

therapeutic endoscopy