Advances in pancreatobiliary endoscopy

Purpose Of review: The role of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) continues to mature. We will review the progress of pancreatobiliary endoscopy in the evaluation and treatment of benign and malignant pancreatobiliary diseases. Recent findings: First, minimizing contrast injection of the pancreas, wire-guided cannulation and prophylactic pancreatic stenting have been re-emphasized in recent studies as the most important endoscopic interventions that can lower the risk of post-ERCP pancreatitis. The role of preoperative ERCP in patients with jaundice secondary to pancreatic cancer was raised in a randomized trial; the widespread use of preoperative biliary drainage is now up for debate. The use of ERCP, intraoperative cholangiography, endoscopic ultrasound and magnetic resonance cholangiopancreatography in the evaluation of suspected common bile duct stones is discussed. We conclude by evaluating studies of fully covered, self-expandable metallic stents, with an emphasis on their potential use in benign biliary disease. Summary: Given the risk of complications and development of alternative imaging modalities, diagnostic ERCP is rarely indicated. However, therapeutic ERCP has been bolstered by advances such as fully covered metallic stents and cholangioscopy.