Indications for and Contraindications to ERCP

Abstract With the exception of pancreaticobiliary manometry for acute relapsing pancreatitis and a subset of patients with Type II sphincter of Oddi dysfunction, the indications for diagnostic ERCP are limited, and diagnostic testing has been replaced by CT, MRCP, and EUS imaging. In contrast, ERCP remains a mainstay in the treatment of choledocholithiasis, bile duct leak, and the palliation of malignant obstructive jaundice. Moreover, pancreatic endotherapy for strictures, stones, and multiple manifestations of pancreatic duct leaks have all become amenable to ERCP. Contraindications to ERCP are relative: visceral perforation, suboptimal anesthesia support, and partially or fully anticoagulated patients. Perhaps more importantly, contraindications include lack of anesthesia support in high-risk patients, postsurgical anatomy without requisite endoscope or accessory equipment, and inadequate training or experience to deal with the individual pancreaticobiliary problem. In the latter setting, an absolute contraindication may be a relative indication in an ERCP referral center.