Trouble Shooting ERCP: Brainstorming of Gastroenterologists
DOI:
https://doi.org/10.52206/jsmc.2024.14.3.932Abstract
Endoscopic Retrograde Cholangiopancreatography is the passion of every budding and experienced gastroenterologist to learn. It does need full-fledged commitment, patience and dedication to learn. It's a bumpy road which even the most trained drivers find very difficult to negotiate. Sometimes the patient ends up getting free in 10 mins, while on the other hand on bad day he gets admitted in the ward for raised inflammatory markers and total leucocyte count due to secondary infection as a result of the procedure due to
wrong technique or due to daunting procedure.
One of the most essential prerequisites for ERCP is careful selection of cases after a detailed workup. Reviewing the deranged liver function test primarily the raised alkaline phosphatase. At times transaminitis can be mistakenly treated as non-alcoholic fatty liver disease and patients being sent home without any workup. The role of the radiologist is of paramount significance. The dilatation of CBD reported on Ultrasound isn't good enough to proceed directly to ERCP. Rather where facilities are available an MRCP should be performed prior to it being non-invasive and having no risks of injuring the pancreatic duct and causing troublesome pancreatitis. Even if the Ultrasound report is normal still an MRCP needs to be advised as that is more accurate.
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