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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2021; 13(8): 260-274
Published online Aug 16, 2021. doi: 10.4253/wjge.v13.i8.260
Endoscopic retrograde cholangiopancreatography: Current practice and future research
David J Sanders, Shivanand Bomman, Rajesh Krishnamoorthi, Richard A Kozarek
David J Sanders, Shivanand Bomman, Rajesh Krishnamoorthi, Richard A Kozarek, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
Author contributions: Sanders DJ and Kozarek RA contributed manuscript concept and inception; Sanders DJ, Bomman S and Krishnamoorthi R contributed drafting of manuscript; Sanders DJ, Bomman S and Krishnamoorthi R, Kozarek RA contributed critical review, revisions and final approval.
Conflict-of-interest statement: Dr. Sanders DJ and Dr. Bomman S has no conflicts of interest related to the nature or content of this article. Dr. Krishnamoorthi R receives research support from Boston Scientific. Dr. Kozarek RA receives research support from Boston Scientific Corporation and the National Institute of Health.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Richard A Kozarek, MD, Doctor, Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, United States. richard.kozarek@virginiamason.org
Received: March 19, 2021
Peer-review started: March 19, 2021
First decision: May 4, 2021
Revised: May 18, 2021
Accepted: July 9, 2021
Article in press: July 9, 2021
Published online: August 16, 2021
Processing time: 145 Days and 8.1 Hours
Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a primarily diagnostic to therapeutic procedure in hepatobiliary and pancreatic disease. Most commonly, ERCPs are performed for choledocholithiasis with or without cholangitis, but improvements in technology and technique have allowed for management of pancreatic duct stones, benign and malignant strictures, and bile and pancreatic leaks. As an example of necessity driving innovation, the new disposable duodenoscopes have been introduced into practice. With the advantage of eliminating transmissible infections, they represent a paradigm shift in quality improvement within ERCP. With procedures becoming more complicated, the necessity for anesthesia involvement and safety of propofol use and general anesthesia has become better defined. The improvements in endoscopic ultrasound (EUS) have allowed for direct bile duct access and EUS facilitated bile duct access for ERCP. In patients with surgically altered anatomy, selective cannulation can be performed with overtube-assisted enteroscopy, laparoscopic surgery assistance, or the EUS-directed transgastric ERCP. Cholangioscopy and pancreatoscopy use has become ubiquitous with defined indications for large bile duct stones, indeterminate strictures, and hepatobiliary and pancreatic neoplasia. This review summarizes the recent advances in infection prevention, quality improvement, pancreaticobiliary access, and management of hepatobiliary and pancreatic diseases. Where appropriate, future research directions are included in each section.

Keywords: Cholangiopancreatography; Endoscopic retrograde; Cholangioscopy; Cannulation; Endoscopic ultrasound; Disposable duodenoscopes

Core Tip: Disposable duodenoscopes present a way to eliminate transmission of drug resistant infections. Access to single operator cholangioscopy and panreatoscopy has made complex intraductal assessment and therapy more ubiquitous. Future research will clarify the role of endoscopic ultrasound bile duct access for variant anatomy or failed endoscopic retrograde cholangiopancreatography (ERCP), photodynamic therapy, and indomethacin and pancreas duct (PD) stents in post ERCP pancreatitis prophylaxis.