Technical guidance of endoscopic pancreatocholangiography

Endoscopic pancreatocholangiography, frequently abbreviated as ERCP, is an X-ray examination of the pancreatic and biliary ducts cannulating the duodenal papilla using the fiberscope. This procedure is the only clinical examination of the pancreatic duct, and is an indispensable technique for endoscopic treatments and further investigations: endoscopic papillotomy, drainage, lithotomy, endoprothesis, pancreatoscopy, and collection and cytology of pure juice. For this examination, a skill in endoscopy is required, and the understanding of the papilla orifice, which consists of prolapsed ampullar folds in the living body, is essential. The catheter should be inserted straight toward the individual duct: the pancreatic and the biliary duct. As ultrasonography and computed tomography are advanced, the clinical roll of ERCP should be reevaluated. However, the pancreatography expresses exactly the ductal pathology, which is reflected by the background pathology of the pancreas: chronic pancreatitis, nonfusion, pancreatobiliary maljunction, small cancerous, mucous-producing tumors, and cystic lesions.