New Guidelines on Gastrointestinal Procedure

The panel noted that while advances in less-invasive imaging techniques will soon eclipse ERCP's value as a diagnostic tool, the procedure continues to be useful in treating benign and malignant diseases of the pancreas and biliary tract. The 13 panelists were from surgery, hepatology, gastroenterology, clincal epidemiology, onocology, biostatistics, health services research, radiology, internal medicine, and the public.

ERCP is currently used to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. ERCP requires conscious sedation and combines the use of x-rays and an endoscope. It allows a doctor to look inside these organs and to inject dye into the bile and pancreatic ducts, making them visible on an x-ray. The panel found that evidence supports ERCP's merit in treating several conditions, including symptomatic gallstone disease, common bile duct stones, recurrent pancreatitis, and pancreatic pseudocysts. However, the panel found ERCP's role unclear in the evaluation or management of abdominal pain without specific anatomic or biochemical abnormalities connected with the common bile duct or pancreas.

The panelists concluded that ERCP remains the best means for diagnosing suspected ampullary cancers and for patients with pancreatic or biliary cancer who are not candidates for surgery. Appropriate training and expertise are necessary, they warned, especially for advanced ERCP. Avoiding unnecessary ERCP is the best way to reduce complications such as post-procedure pancreatitis. The panel advocated randomized, prospective trials to assess both benefits and risks of ERCP compared to other interventions for biliary and pancreatic problems. The full text of the panel's statement is available at http://consensus.nih.gov.




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