[Indications for and effectiveness of retrograde cholangiopancreatography]

The practical value of endoscopic retrograde cholangiopancreatography (ERCP) has been evaluated on the basis of experience in 159 own examinations. The cannulation rate as an important index of the success rate rose with experience, and was 85 percent in the last 110 cases. Diagnostic information was however obtained only in 65 percent, as it was not always possible to cannulate the appropriate ductule system and differentiation between chronic inflammatory and neoplastic pancreatic disease was often difficult. The greatest reliability was found in bilary duct disease, though the difference as compared with pancreatic disease was not significant. With strict limitation of the indication and a few important precautions (avoiding parenchymography of the pancreas and prompt surgical drainage of an obstructed biliary duct or pancreatic pseudocysts) no severe complications were observed throughout this series. The morbidity was thus limited to 4 cases of pancreatitis of moderate severity. In spite of the limitations of ERCP in differentiating malignant from chronic inflammatory pancreatic disease, the method was valuable for establishing the indication for, and planning, surgery. Furthermore, the diagnostic reliability was improved by combining ERCP with selective pancreatic angiography.