Updates in biliary endoscopy

Abstract

Endoscopic retrograde cholangiopancreatography is a non-surgical approach to diseases of the pancreaticobiliary system that dates back to the late 1960s. Initially, endoscopic retrograde cholangiopancreatography was purely a diagnostic procedure. After the first report of endoscopic sphincterotomy in 1974, therapeutic uses were possible for diseases that previously required surgery. As therapeutic indications broaden, our understanding of complications has tempered the initial excitement. Non-invasive imaging in many circumstances has replaced the diagnostic utilization of endoscopic retrograde cholangiopancreatography which is now reserved primarily for therapeutic indications. This review is intended to address biliary therapeutics with an update on the recent directions of this field. Advancements in the endoscopic retrograde cholangiopancreatography medical literature in the last year have concentrated on the management of difficult common bile duct stones using electrohydraulic lithotripsy, chronic pancreatitis and pancreatic cancer-induced biliary strictures, postoperative bile leaks, the use of newer methods of biliary access and finally the use of ulinastatin for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. This is an update of the work in the field of biliary endoscopy over the last year. The goal of this review is to address specific management concerns in the field of biliary endoscopy from the literature published in 2005.