What is the role of endoscopic retrograde cholangiopancreatography (ERCP) in the workup of postcholecystectomy syndrome (PCS)?

Updated: Nov 28, 2018
  • Author: Steen W Jensen, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

ERCP is the most useful test in the diagnosis of PCS. [13, 14] It is unsurpassed in visualization of the ampulla, biliary, and pancreatic ducts. At least 50% of patients with PCS have biliary disease, and most of these patients’ conditions are functional in nature. An experienced endoscopist can confirm this diagnosis in most of these patients and can also provide additional diagnostic studies, such as biliary and ampullary manometry.

Delayed emptying can be observed during ERCP, as well as with hepatoiminodiacetic acid (HIDA) scanning. The CBD should clear of contrast within 45 minutes. Biliary manometry is performed in patients sedated without narcotics with a perfusion catheter; a pull-through technique is used for sphincter manometry. The sphincter is 5-10 mm long, and normal pressures are less than 30 mm Hg.

As technology improves, it will be easier to detect retrograde contractions or increased frequency of contractions (also called tachyoddia).

At the time of ERCP, therapeutic maneuvers, such as stone extraction, stricture dilatation, or sphincterotomy for dyskinesia or sphincter of Oddi stenosis, can be performed. Percutaneous transhepatic cholangiography (PTC) or magnetic resonance cholangiopancreatography (MRCP) may be of use in patients who are not candidates for ERCP or in whom ERCP has been unsuccessfully attempted.


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