<s>
Endoscopic	B-Algorithm
retrograde	I-Algorithm
cholangiopancreatography	I-Algorithm
(	O
ERCP	B-Algorithm
)	O
is	O
a	O
technique	O
that	O
combines	O
the	O
use	O
of	O
endoscopy	B-Application
and	O
fluoroscopy	O
to	O
diagnose	O
and	O
treat	O
certain	O
problems	O
of	O
the	O
biliary	O
or	O
pancreatic	O
ductal	O
systems	O
.	O
</s>
<s>
Through	O
the	O
endoscope	O
,	O
the	O
physician	O
can	O
see	O
the	O
inside	O
of	O
the	O
stomach	O
and	O
duodenum	O
,	O
and	O
inject	O
a	O
contrast	B-Algorithm
medium	I-Algorithm
into	O
the	O
ducts	O
in	O
the	O
biliary	O
tree	O
and	O
pancreas	O
so	O
they	O
can	O
be	O
seen	O
on	O
radiographs	O
.	O
</s>
<s>
ERCP	B-Algorithm
is	O
used	O
primarily	O
to	O
diagnose	O
and	O
treat	O
conditions	O
of	O
the	O
bile	O
ducts	O
and	O
main	O
pancreatic	O
duct	O
,	O
including	O
gallstones	O
,	O
inflammatory	O
strictures	O
(	O
scars	O
)	O
,	O
leaks	O
(	O
from	O
trauma	O
and	O
surgery	O
)	O
,	O
and	O
cancer	O
.	O
</s>
<s>
ERCP	B-Algorithm
can	O
be	O
performed	O
for	O
diagnostic	O
and	O
therapeutic	O
reasons	O
,	O
although	O
the	O
development	O
of	O
safer	O
and	O
relatively	O
non-invasive	O
investigations	O
such	O
as	O
magnetic	B-Algorithm
resonance	I-Algorithm
cholangiopancreatography	I-Algorithm
(	O
MRCP	B-Algorithm
)	O
and	O
endoscopic	B-Algorithm
ultrasound	I-Algorithm
has	O
meant	O
that	O
ERCP	B-Algorithm
is	O
now	O
rarely	O
performed	O
without	O
therapeutic	O
intent	O
.	O
</s>
<s>
The	O
following	O
represent	O
indications	O
for	O
ERCP	B-Algorithm
,	O
particularly	O
if	O
or	O
when	O
less	O
invasive	O
options	O
are	O
not	O
adequate	O
or	O
definitive	O
:	O
</s>
<s>
Pancreatic	O
tumors	O
no	O
longer	O
represent	O
a	O
valid	O
diagnostic	O
indication	O
for	O
ERCP	B-Algorithm
unless	O
they	O
cause	O
bile	O
duct	O
obstruction	O
and	O
jaundice	O
.	O
</s>
<s>
ERCP	B-Algorithm
may	O
be	O
indicated	O
in	O
the	O
above	O
diagnostic	O
scenarios	O
when	O
any	O
of	O
the	O
following	O
are	O
needed	O
:	O
</s>
<s>
Hypersensitivity	O
to	O
iodinated	B-Algorithm
contrast	I-Algorithm
medium	I-Algorithm
or	O
a	O
history	O
of	O
iodinated	B-Algorithm
contrast	I-Algorithm
dye	O
anaphylaxis	O
is	O
not	O
a	O
contraindication	O
of	O
ERCP	B-Algorithm
,	O
though	O
it	O
should	O
be	O
discussed	O
with	O
your	O
health	O
provider	O
,	O
and	O
you	O
should	O
tell	O
them	O
you	O
are	O
allergic	O
to	O
iodine	O
,	O
as	O
an	O
alternative	O
contrast	O
iodine-free	O
material	O
(	O
"	O
dye	O
"	O
)	O
is	O
then	O
injected	O
gently	O
into	O
the	O
ducts	O
(	O
pancreatic	O
or	O
biliary	O
)	O
and	O
x-rays	O
are	O
taken	O
.	O
</s>
<s>
The	O
region	O
can	O
be	O
directly	O
visualized	O
with	O
the	O
endoscopic	B-Application
camera	O
while	O
various	O
procedures	O
are	O
performed	O
.	O
</s>
<s>
When	O
needed	O
,	O
the	O
sphincters	O
of	O
the	O
ampulla	O
and	O
bile	O
ducts	O
can	O
be	O
enlarged	O
by	O
a	O
cut	O
(	O
sphincterotomy	B-Algorithm
)	O
with	O
an	O
electrified	O
wire	O
called	O
a	O
sphincterotome	O
for	O
access	O
into	O
either	O
so	O
that	O
gallstones	O
may	O
be	O
removed	O
or	O
other	O
therapy	O
performed	O
.	O
</s>
<s>
Other	O
procedures	O
associated	O
with	O
ERCP	B-Algorithm
include	O
the	O
trawling	O
of	O
the	O
common	O
bile	O
duct	O
with	O
a	O
basket	O
or	O
balloon	O
to	O
remove	O
gallstones	O
and	O
the	O
insertion	O
of	O
a	O
plastic	O
stent	O
to	O
assist	O
the	O
drainage	O
of	O
bile	O
.	O
</s>
<s>
However	O
,	O
magnetic	O
resonance	O
imaging	O
(	O
MRI	B-Algorithm
)	O
offers	O
diagnostic	O
capabilities	O
similar	O
to	O
those	O
of	O
CT	O
,	O
with	O
additional	O
intrinsic	O
advantages	O
including	O
lack	O
of	O
ionizing	O
radiation	O
and	O
exquisite	O
soft	O
tissue	O
characterization	O
.	O
</s>
<s>
In	O
specific	O
cases	O
,	O
other	O
specialized	O
or	O
ancillary	O
endoscopes	B-Application
may	O
be	O
used	O
for	O
ERCP	B-Algorithm
.	O
</s>
<s>
One	O
of	O
the	O
most	O
frequent	O
and	O
feared	O
complications	O
after	O
endoscopic	B-Algorithm
retrograde	I-Algorithm
cholangiopancreatography	I-Algorithm
(	O
ERCP	B-Algorithm
)	O
is	O
post-ERCP	O
pancreatitis	O
(	O
PEP	O
)	O
.	O
</s>
<s>
Risk	O
factors	O
for	O
developing	O
PEP	O
include	O
technical	O
matters	O
related	O
to	O
the	O
ERCP	B-Algorithm
procedure	O
and	O
patient-specific	O
ones	O
.	O
</s>
<s>
Intestinal	O
perforation	O
is	O
a	O
risk	O
of	O
any	O
gastroenterologic	O
endoscopic	B-Application
procedure	O
,	O
and	O
is	O
an	O
additional	O
risk	O
if	O
a	O
sphincterotomy	B-Algorithm
is	O
performed	O
.	O
</s>
<s>
Sphincterotomy	B-Algorithm
is	O
also	O
associated	O
with	O
a	O
risk	O
of	O
bleeding	O
.	O
</s>
<s>
ERCP	B-Algorithm
may	O
provoke	O
hemobilia	O
from	O
trauma	O
to	O
friable	O
hilar	O
tumors	O
or	O
a	O
guide-wire	O
penetrating	O
the	O
bile	O
duct	O
wall	O
,	O
creating	O
a	O
biliary	O
fistula	O
.	O
</s>
<s>
Delayed	O
bleeding	O
is	O
a	O
rare	O
but	O
potentially	O
serious	O
complication	O
of	O
sphincterotomy	B-Algorithm
,	O
particularly	O
as	O
many	O
patients	O
are	O
discharged	O
home	O
within	O
hours	O
of	O
ERCP	B-Algorithm
.	O
</s>
<s>
There	O
is	O
also	O
a	O
risk	O
associated	O
with	O
the	O
contrast	B-Algorithm
dye	I-Algorithm
in	O
patients	O
who	O
are	O
allergic	O
to	O
compounds	O
containing	O
iodine	O
,	O
which	O
can	O
be	O
very	O
severe	O
,	O
even	O
if	O
the	O
anaphylactoid	O
reactions	O
occur	O
while	O
you	O
are	O
in	O
a	O
hospital	O
.	O
</s>
<s>
In	O
rare	O
cases	O
,	O
ERCP	B-Algorithm
can	O
cause	O
fatal	O
complications	O
.	O
</s>
<s>
The	O
FDA	O
issued	O
a	O
safety	O
communication	O
"	O
Design	O
of	O
ERCP	B-Algorithm
Duodenoscopes	O
May	O
Impede	O
Effective	O
Cleaning	O
"	O
in	O
February	O
2015	O
,	O
which	O
was	O
updated	O
in	O
December	O
2015	O
,	O
and	O
more	O
recently	O
in	O
2022	O
which	O
recommended	O
disposable	O
components	O
.	O
</s>
