Marcia K. Bilbao

Endoscopic retrograde cholangiopancreatography (ERCP). Experience with 100 cases.

Endoscopic visualization of the papilla of Vater was achieved in 98 of our first 100 attempts. Cannulation was successful in 87% of cases, achieving pancreatography alone in 29, cholangiography alone in 27, and both in 31. The relevant duct was adequately visualized in 72.5% of patients with biliary tract disease and in 72% of those with pancreatic disease. Complications were acceptably few. The procedure has proven valuable in difficult cases of obstructive jaundice and biliary type pain syndromes without jaundice. Many questions remain, however, as to its value in the diagnosis and evaluation of pancreatic disease.

Endoscopic retrograde cholangiopancreatography in patients with gastrectomy and gastrojejunostomy (Billroth II). A case for the forward look

Endoscopic cannulation of the duodenal papilla in patients with gastrojejunostomy presents special problems that have been solved by these authors who recommend use of the forward viewing instrument. Particular caution is urged in endoscopy of the afferent limb.

Endoscopic retrograde cholangiopancreatography (ERCP): Radiographic technique

The diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP) is fully exploited only if the radiographs obtained are of excellent quality. Careful attention to factors such as type of fluoroscopic equipment, small focal spot, and adequate preliminary films are an important requisite. Using fluoroscopy to locate the ampullary region and to monitor the extent of filling of pancreatic and biliary ductal system during contrast injection speeds completion of the study and helps prevent complications. Performing ERCP with attention to patient positioning and awareness of possible need for delayed radiographs also enhances its diagnostic capability.

Postbulbar duodenal ulcer and ring-stricture. Cause and effect.

Abstract A longitudinal study including repeated hypotonic duodenography examinations was performed on 12 patients with ring-stricture of the descending duodenum. Findings included a common clinical pattern of years of undiagnosed symptoms despite multiple upper gastrointestinal examinations and a characteristic progression of a descending duodenal ulcer to a fixed 2–3 mm stricture diagnosed only by hypotonic duodenography. Surgical proof was obtained only when the duodenum was opened, palpated, and inspected visually from within. Such strictures are not congenital but indicate peptic ulcer disease; they are usually undiagnosed. If suspected, hypotonic duodenography is indicated.

Reflux Cholangiography in Sphincteroplasty or Enterobiliary Anastomosis

Reflux cholangiography is an extension of hypotonic duodenography. In patients with abnormal enterobiliary communications, it is a rapid, effective method for demonstrating not only biliary and occasionally pancreatic ducts, but also fistulas, the duodenum, and the papilla of Vater. It is especially useful for preoperative evaluation of strictures for it enhances both the value and success of endoscopic cholangiopancreatography.