Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP is used to image the biliary and pancreatic systems fluoroscopically using IR and IE techniques to diagnose and treat disease of the biliary or pancreatic systems.27 Using a side-view duodenoscope, this procedure is performed by cannulating the major duodenal papilla to access the common bile duct. A sphincterotomy is performed to widen the papilla and a biliary stent can be placed into the bile duct for decompression of extrahepatic bile duct obstructions. This is performed per os using endoscopy and fluoroscopy simultaneously in a retrograde, minimally invasive fashion. This therapeutic modality is currently being investigated in a research setting in veterinary patients (Figure 10).
Figure 10. Endoscopic retrograde cholangiopancreatography (ERCP) in a research dog. (A) Endoscopic image through side-view duodenoscope of sphincterotome (S) advanced into bile duct opening on major duodenal papilla. (B) Endoscopic image of guidewire (black arrows) advanced up common bile duct and biliary stent (asterisk) advanced over-the-wire. (C) Fluoroscopic image demonstrating duodenoscope (DS) with guidewire (black arrow) advanced up common bile duct. The biliary stent (white arrows) is advanced over-the-guidewire. The gall bladder (GB) is filled with contrast. (D) Final endoscopic image of biliary stent (asterisk) in place exiting the major duodenal papilla.