Editing Endoscopic retrograde cholangiopancreatography (section)

==Procedure==
[[File:Detailed diagram of an endoscopic retrograde cholangio pancreatography (ERCP) CRUK 001.svg|thumb|left|Diagram of an endoscopic retrograde cholangiopancreatography (ERCP)]]
The patient is sedated or anaesthetized. Then a flexible camera ([[endoscope]]) is inserted through the mouth, down the esophagus, into the stomach, through the [[pylorus]] into the [[duodenum]] where the [[ampulla of Vater]] (the union of the common bile duct and pancreatic duct) exists. The [[sphincter of Oddi]] is a muscular valve that controls the opening to the ampulla. The region can be directly visualized with the endoscopic camera while various procedures are performed. A plastic catheter or ''[[Wikt:cannula|cannula]]'' is inserted through the ampulla, and radiocontrast is injected into the bile ducts and/or pancreatic duct. [[Fluoroscopy]] is used to look for blockages, or other lesions such as stones.<ref>{{cite web | url=https://www.niddk.nih.gov/health-information/diagnostic-tests/endoscopic-retrograde-cholangiopancreatography | title=Endoscopic Retrograde Cholangiopancreatography (ERCP) &#124; NIDDK }}</ref><ref>{{cite web | url=https://smarttechmed.com/endoscope-bending-rubber/| title=Endoscopie bending rubber}}</ref>

When needed, the sphincters of the ampulla and bile ducts can be enlarged by a cut (sphincterotomy) with an electrified wire called a sphincterotome for access into either so that gallstones may be removed or other therapy performed.<ref>{{cite journal | pmc=4250869 | year=2007 | last1=Deng | first1=D. H. | last2=Zuo | first2=H. M. | last3=Wang | first3=J. F. | last4=Gu | first4=Z. E. | last5=Chen | first5=H. | last6=Luo | first6=Y. | last7=Chen | first7=M. | last8=Huang | first8=W. N. | last9=Wang | first9=L. | last10=Lu | first10=W. | title=New precut sphincterotomy for endoscopic retrograde cholangiopancreatography in difficult biliary duct cannulation | journal=World Journal of Gastroenterology | volume=13 | issue=32 | pages=4385–4390 | doi=10.3748/wjg.v13.i32.4385 | pmid=17708616 | doi-access=free }}</ref>

Other procedures associated with ERCP include the trawling of the common bile duct with a basket or balloon to remove gallstones and the insertion of a plastic [[stent]] to assist the drainage of bile.<ref>{{cite journal | pmc=2397011 | year=2008 | last1=Kelly | first1=N. M. | last2=Caddy | first2=G. R. | title=Successful Endoscopic Management of Fractured Dormia Basket During Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis | journal=The Ulster Medical Journal | volume=77 | issue=1 | pages=56–58 | pmid=18271088 }}</ref> Also, the pancreatic duct can be cannulated and stents be inserted.

The pancreatic duct requires visualisation in cases of pancreatitis. Ultrasound is frequently the first investigation performed on admission; although it has little value in the diagnosis of pancreatitis or its complications. contrast-enhanced computed tomography (MD-CECT) is the most used imaging technique. However, magnetic resonance imaging (MRI) offers diagnostic capabilities similar to those of CT, with additional intrinsic advantages including lack of ionizing radiation and exquisite soft tissue characterization.<ref>{{cite journal | pmc=4133524 | year=2014 | last1=Busireddy | first1=K. K. | last2=Alobaidy | first2=M. | last3=Ramalho | first3=M. | last4=Kalubowila | first4=J. | last5=Baodong | first5=L. | last6=Santagostino | first6=I. | last7=Semelka | first7=R. C. | title=Pancreatitis-imaging approach | journal=World Journal of Gastrointestinal Pathophysiology | volume=5 | issue=3 | pages=252–270 | doi=10.4291/wjgp.v5.i3.252 | pmid=25133027 | doi-access=free }}</ref>

In specific cases, other specialized or ancillary endoscopes may be used for ERCP. These include mother-baby and SpyGlass cholangioscopes (to help in diagnosis by directly visualizing the duct as opposed to only obtaining X-ray images<ref>{{EMedicine|article|1891395|Cholangioscopy|technique}}</ref><ref>{{cite journal |doi=10.1016/j.gie.2016.03.013 |title=Cholangiopancreatoscopy |year=2016 |last1=Komanduri |first1=Sri |last2=Thosani |first2=Nirav |last3=Abu Dayyeh |first3=Barham K. |last4=Aslanian |first4=Harry R. |last5=Enestvedt |first5=Brintha K. |last6=Manfredi |first6=Michael |last7=Maple |first7=John T. |last8=Navaneethan |first8=Udayakumar |last9=Pannala |first9=Rahul |last10=Parsi |first10=Mansour A. |last11=Smith |first11=Zachary L. |last12=Sullivan |first12=Shelby A. |last13=Banerjee |first13=Subhas |last14=Banerjee |first14=S. |journal=Gastrointestinal Endoscopy |volume=84 |issue=2 |pages=209–221 |pmid=27236413 |doi-access=free }}</ref><ref name="pmid15933927">{{cite journal |vauthors=Farrell JJ, Bounds BC, Al-Shalabi S, Jacobson BC, Brugge WR, Schapiro RH, Kelsey PB |title=Single-operator duodenoscope-assisted cholangioscopy is an effective alternative in the management of choledocholithiasis not removed by conventional methods, including mechanical lithotripsy |journal=Endoscopy |volume=37 |issue=6 |pages=542–7 |year=2005 |pmid=15933927 |doi=10.1055/s-2005-861306|s2cid=260128740 }}</ref>) as well as balloon enteroscopes (e.g. in patients that have previously undergone [[digestive system surgery]] with post-[[Pancreaticoduodenectomy|Whipple]] or [[Roux-en-Y anastomosis|Roux-en-Y]] surgical anatomy).<ref>{{cite journal |last1=Azeem |first1=Nabeel |last2=Tabibian |first2=James H. |last3=Baron |first3=Todd H. |last4=Orhurhu |first4=Vwaire |last5=Rosen |first5=Charles B. |last6=Petersen |first6=Bret T. |last7=Gostout |first7=Christopher J. |last8=Topazian |first8=Mark D. |last9=Levy |first9=Michael J. |title=Use of a single-balloon enteroscope compared with variable-stiffness colonoscopes for endoscopic retrograde cholangiography in liver transplant patients with Roux-en-Y biliary anastomosis |journal=Gastrointestinal Endoscopy |date=April 2013 |volume=77 |issue=4 |pages=568–577 |doi=10.1016/j.gie.2012.11.031 |pmid=23369652 }}</ref>