Endoscopic retrograde cholangiopancreatography and sphincterotomy.

Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic technique to evaluate patients with biliary and pancreatic disease. Since 1970, over 1000 ERCPs in the Surgical Endoscopy Unit of Beth Israel Medical Center have been performed; this report summarizes the most recent 300 cases. This paper will document the indications and methodology as well as the improved morbidity and mortality rates associated with this procedure. In contrast to earlier reports, the incidence of hyperamylasemia is now 8.3% and clinical pancreatitis, 2.3%. Cholangitis occurred in less than 1% of patients. In addition, 40 patients had endoscopic sphincterotomy. Retained and recurrent common duct stones were the most frequent indications for this procedure. There was one death. In another patient, a duodenal perforation was treated successfully by antibiotics and parenteral fluids. We believe this technique has many advantages over choledochotomy in properly selected patients.