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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 25, 2015; 7(11): 1023-1031
Published online Aug 25, 2015. doi: 10.4253/wjge.v7.i11.1023
Endoscopic retrograde pancreatography: When should we do it?
Renáta Bor, László Madácsy, Anna Fábián, Attila Szepes, Zoltán Szepes
Renáta Bor, Anna Fábián, Zoltán Szepes, First Department of Medicine, University of Szeged, 6720 Szeged, Hungary
László Madácsy, Attila Szepes, Bács-Kiskun County Hospital, 6000 Kecskemét, Hungary
Author contributions: All authors contributed to this paper.
Conflict-of-interest statement: No conflict of interest is declared by any of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Zoltán Szepes, Medicinae Doctor, Doctor of Philosophy, First Department of Medicine, University of Szeged, Korányi Fasor 8-10, 6720 Szeged, Hungary. szepes.zoltan@med.u-szeged.hu
Telephone: +36-62-545189 Fax: +36-62-545185
Received: May 16, 2015
Peer-review started: May 16, 2015
First decision: June 18, 2015
Revised: June 24, 2015
Accepted: August 13, 2015
Article in press: August 14, 2015
Published online: August 25, 2015
Processing time: 104 Days and 18 Hours
Abstract

Endoscopic retrograde pancreatography (ERP) is an accurate imaging modality in the diagnosis of pancreatobiliary diseases. However, its use has been substantially reduced due to the invasiveness of procedure, the risk of complications and the widespread availability of non-invasive cross-section imaging techniques (computed tomography, magnetic resonance imaging, and endoscopic ultrasound). Since the introduction of endoscopic sphincterotomy, ERP has transformed from diagnostic method to an almost exclusively therapeutic procedure. Pancreatic duct injection substantially increased the risk of post-ERP pancreatitis (1.6%-15.7%); therefore, according to international guidelines ERP is recommended only in cases where biliary intervention is required. However, the role of ERP in the management of pancreatic diseases is currently not clearly defined, but in some cases the filling of pancreatic duct may provide essential information complementing the results of non-invasive imaging techniques. The aim of this publication is to systematically summarize the literature dealing with the diagnostic yield of ERP. We would like to define the precise indications of ERP and overview a diagnostic protocol of pancreatic diseases depending on international guidelines and the opinion of Hungarian experts, because it may improve the diagnostic accuracy, minimize of burden of patients and reduce the risk of procedure related complications.

Keywords: Endoscopic retrograde cholangiopancreatography; Endoscopic pancreatography; Autoimmune pancreatitis; Pancreas divisum; Chronic pancreatitis

Core tip: Since the development and widespread availability of non-invasive imaging techniques the importance of diagnostic endoscopic pancreatography (ERP) has substantially reduced. However, in some complicated cases or during pancreatic interventional endoscopic procedures such as minor papilla sphincterotomy, pancreatic sphincterotomy, pancreatic stent implantation, ERP may provide essential information. This article seeks to summarize the results of previous studies and recommendations of international guidelines to define the diagnostic yield and correct indications of ERP.