Endoscopic retrograde cholangiopancreatography in the next millennium

Rapid technologic advances in radiologic imaging and laparoscopic surgery are redefining the indications for endoscopic retrograde cholangiopancreatography (ERCP). The diagnostic role of ERCP continues to diminish in favor of newer imaging modalities such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography. Laparoscopic surgery recaptures some of the indications for therapeutic intervention. The spectrum of diagnostic and therapeutic applications of ERCP, however, continues to expand, enabling a more differentiated diagnosis and treatment of biliopancreatic disease. These applications include ongoing developments of cholangioscopy, pancreatoscopy, and molecular analysis of biliary and pancreatic secretions, photodynamic therapy, and gene therapy.