Diagnostic ERCP

The decline of diagnostic endoscopic retrograde cholangiopancreatography (ERCP) continues. It has been replaced by endoscopic ultrasound or magnetic resonance cholangiopancreatography (MRCP) in numerous institutions. The role rapidly acquired by MRCP in the diagnostic work-up of pancreaticobiliary disease is impressive. MRCP is now challenging ERCP in one of its final indications - the assessment of primary sclerosing cholangitis. However, ERCP does not only consist of obtaining a cholangiogram or pancreatogram. ERCP referred more generally to the endoscopic retrograde approach to the pancreaticobiliary ducts. This endoscopic approach allows numerous procedures that cannot be accomplished using noninvasive techniques and which,are complementary to them, such as fluid collection, biliary or pancreatic tissue sampling, sphincter of Oddi manometry, intraductal ultrasound, choledochoscopy, and pancreatoscopy. The diagnostic role of pancreatoscopy and choledochoscopy is questionable, whereas the application of molecular biology to the diagnosis of pancreaticobiliary cancer might give ERCP a second chance. Although ERCP per se may be declining, the endoscopic approach to the pancreaticobiliary ducts certainly still has good prospects.