1. KADA DA, A KADA NE ERCP Prof.dr.sc.Žarko Babić KB Dubrava, Zagreb Klinika za unutarnje bolesti Zavod za gastroenterologiju Odjel za gastroenterologiju

2. Indications Evaluation of chronic pancreatitis Recurrent cholangitis Evaluation of possible cancer of the biliary tree and/or pancreas Choledocholithiasis (ductal stones) Removal of retained bile or pancreatic stones Pre- or post-operative cholecystectomy when ductal stones are suspected Chronic or acute abdominal pain when bile duct disease is suspected

3. Indications Suspected primary sclerosing cholangitis (PSC) Evaluation of abnormal biliary system findings from a CT, EUS or MRCP Obstructive jaundice Dilated CBD (common bile duct) Tissue sampling

4. Indications Biliary strictures Sphincter of Oddi dysfunction Palliative or pre-operative stenting of malignant biliary or pancreatic strictures Treatment of bile leaks (biliary ducts or pancratic duct) Pancreatic fluid colections (pseudocysts and necrosis-that communicate with pancreatic duct)

5. Indications-conclusion TODAY: Therapeutic ERCP Always is indicated in: -Conditions that need immidiate attention and resolution (diagnostic, therapeutic-papilotomy, dilatation, drainage, stenting, ampulectomy etc.) -Bile duct (pancreatic duct) dilatation with laboratory signs of cholestasis (  bilirubin, GGT, ALP)

6. Contraindications MAJOR: The risk of sedation GENERAL: Recent myocardial infarction Visceral perforation, Risk of perforation – (some duodenal diverticula, anatomyc abnormalities) Recent barium enema-superposition Who cannot cooperate RELATIVE: 1) Patient’s needs vrs. Patient’s current condition (eg.: may be unstabile due to an infection that is resolved with procedure-biliary sepsis) 2) Coagulopathy (correction !)