Answer
Endoscopic retrograde cholangiopancreatography (ERCP) is both diagnostic and therapeutic and is considered the criterion standard for imaging the biliary system.
ERCP should be reserved for patients who may require therapeutic intervention. Patients with a high clinical suspicion for cholangitis should proceed directly to ERCP.
ERCP has a high success rate (98%) and is considered safer than surgical and percutaneous intervention.
Diagnostic use of ERCP carries a complication rate of approximately 1.38% and a mortality rate of 0.21%. The major complication rate of therapeutic ERCP is 5.4%, and it has a mortality rate of 0.49%. Complications include pancreatitis, bleeding, and perforation. [16]
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Media Gallery
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Sonogram of dilated intrahepatic ducts.
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CT scan of common bile duct occluded by stone. Image courtesy of David Schwartz, MD, New York University Hospital.
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CT scan of 1-cm dilated common bile duct at portal triad. Image courtesy of David Schwartz, MD, New York University Hospital.
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CT scan of dilated intrahepatic bile ducts. Image courtesy of David Schwartz, MD, New York University Hospital.
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Algorithm for management of patients with acute cholangitis.
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