Diagnostic ERCP

ERCP is a medical procedure that is used to diagnose and sometimes treat certain issues occurring within the bile or pancreatic ducts, particularly blockages or restrictions. If an ERCP is performed only to determine the cause of the issue, it is considered a diagnostic ERCP.

ERCP for Diagnosis

During a diagnostic ERCP, the physician will insert a lighted endoscope into the patient’s mouth. This is then carefully moved through their esophagus, stomach, and into the opening of the small intestine. When the opening is reached that is common to both the biliary ducts and pancreatic ducts, a tube is inserted into the center of the endoscope.

A dye, known as a contrast medium, is ran thought the tube. X-rays are then taken. The contrast medium helps to highlight the areas of interest, and may alert the physician of a blockage or other issue that would not have been visible otherwise. A modern endoscope is also fitted with video equipment, giving the physician another means of diagnosis.


Diagnostic ERCP Symptoms

A doctor may recommend a diagnostic ERCP to find the root cause of certain symptoms or health conditions, such as:

  • Jaundice
  • Suspected bile or pancreatic duct damage
  • Tumors or masses visible on CT Scan
  • Confirmation of cancers in effected organs
  • Suspected dysfunction of certain sphincters
  • Gallstones appearing on ultrasonography

In the past, pancreatic tumors were considered a cause for diagnostic ERCP. However, endoscopic ultrasound is now considered a safer and more effective diagnostic tool for this condition. If it is suspected that pancreatic tumors are causing a blockage of the duct, ERCP may be recommended in order to correct the condition, but typically not just for diagnostic purposes.

Effective ERCP Cases

When considering medical treatments, an ERCP is less invasive than many abdominal procedures. However, when used for biliary diagnosis, an ERCP is considered an invasive and high risk diagnostic procedure. For this reason, ERCP procedures are primarily meant for patients with biliary conditions that can be treated immediately after diagnosis. This means that the ERCP doctor should have good reason to believe the patient’s medical condition can be diagnosed and treated during the same procedure. If the ERCP doctor does not think this is likely, then an ERCP procedure might not be worth the risk.

Diagnostic ERCP Alternatives

Magnetic resonance cholangiopancreatography, or MRCP, is considered a safer alternative to diagnostic ERCP. An MRCP is a type of MRI specifically focused on the bile and pancreatic ducts. There are mixed reviews on whether it is as effective in diagnosing the cause of blockages and restrictions as ERCP. Ultrasounds and CT scans may also be used, especially as a first step in diagnosing abdominal problems.


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Kaltenthaler, Eva, Stephen Walters, et al. “MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review.” BMC Medical Imaging. Biomed Central, LTD, 14 Aug 2006. Web. 27 Jun 2013. <http://www.biomedcentral.com/1471-2342/6/9>.

“Complications of diagnostic and therapeutic ERCP: a prospective multicenter study.” PubMed.gov. National Center for Biotechnology Information, U.S. National Library of Medicine, n.d. Web. 27 Jun 2013. <http://www.ncbi.nlm.nih.gov/pubmed/11232684>.