WordNet

of amnesia; affecting time immediately preceding trauma
go back over; "retrograde arguments" (同)rehash, hash over
move back; "The glacier retrogrades" (同)retreat
going from better to worse (同)retrogressive
move backward in an orbit, of celestial bodies
move in a direction contrary to the usual one; "retrograding planets"
moving from east to west on the celestial sphere; or--for planets--around the sun in a direction opposite to that of the Earth
of or relating to endoscopy

PrepTutorEJDIC

後戻りする,後退する / 悪化する / (生物が)退化する / 後退する,逆行する / 悪くなる / 〈生物が〉退化する

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/06/14 16:51:19」(JST)

wiki en

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject radiographic contrast into the ducts in the biliary tree and pancreas so they can be seen on X-rays.

ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct,^[1] including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP can be performed for diagnostic and therapeutic reasons, although the development of safer and relatively non-invasive investigations such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound has meant that ERCP is now rarely performed without therapeutic intent.

Diagnostic[edit]

Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct. A nasobiliary tube has been inserted.

Fluoroscopic image showing dilatation of the pancreatic duct during ERCP investigation. Endoscope is visible.

Obstructive jaundice - This may be due to several causes
Chronic pancreatitis - a now controversial indication due to widespread availability of safer diagnostic modalities including endoscopic ultrasound, high-resolution CT, and MRI/MRCP
Gallstones with dilated bile ducts on ultrasonography
Bile duct tumors
Suspected injury to bile ducts either as a result of trauma or iatrogenic
Sphincter of Oddi dysfunction
Pancreatic tumors no longer represent a valid diagnostic indication for ERCP unless they cause bile duct obstruction and jaundice. Endoscopic ultrasound represents a safer and more accurate diagnostic alternative

Therapeutic[edit]

Any of the above when the following may become necessary
- Endoscopic sphincterotomy (both of the biliary and the pancreatic sphincters)
- Removal of stones
- Insertion of stent(s)
- Dilation of strictures (e.g. primary sclerosing cholangitis, anastomotic strictures after liver transplantation)

Contraindications[edit]

Acute pancreatitis (unless persistently raised or worsening bilirubin suggests ongoing obstruction)
Pancreatic pseudocyst
Previous pancreatoduodenectomy
Coagulation disorder
Recent myocardial infarction
Inadequate surgical back-up
History of contrast dye anaphylaxis
Poor health condition for surgery
Severe cardiopulmonary disease

Procedure[edit]

The patient is sedated or anaesthetized. Then a flexible camera (endoscope) is inserted through the mouth, down the esophagus, into the stomach, through the pylorus into the duodenum where the ampulla of Vater (the opening of the common bile duct and pancreatic duct) exists. The sphincter of Oddi is a muscular valve that controls the opening of the ampulla. The region can be directly visualized with the endoscopic camera while various procedures are performed. A plastic catheter or cannula is inserted through the ampulla, and radiocontrast is injected into the bile ducts and/or pancreatic duct. Fluoroscopy is used to look for blockages, or other lesions such as stones.

When needed, the opening of the ampulla can be enlarged (sphincterotomy) with an electrified wire (sphincterotome) and access into the bile duct obtained so that gallstones may be removed or other therapy performed.

Other procedures associated with ERCP include the trawling of the common bile duct with a basket or balloon to remove gallstones and the insertion of a plastic stent to assist the drainage of bile. Also, the pancreatic duct can be cannulated and stents be inserted. The pancreatic duct requires visualisation in cases of pancreatitis.

In specific cases, a second camera can be inserted through the channel of the first endoscope. This is termed duodenoscope-assisted cholangiopancreatoscopy (DACP) or mother-daughter ERCP. The daughter scope can be used to administer direct electrohydraulic lithotripsy to break up stones, or to help in diagnosis by directly visualizing the duct (as opposed to obtaining X-ray images).^[2]

The gallbladder should be surgically removed (cholecystectomy) following successful removal of gallstones from the bile ducts.^[3]

Risks[edit]

The major risk of an ERCP is the development of pancreatitis, which can occur in up to 5% of all procedures. This may be self limited and mild, but may require hospitalization, and rarely, may be life-threatening. Patients at additional risk for pancreatitis are younger patients, patients with previous post-ERCP pancreatitis, females, procedures that involve cannulation or injection of the pancreatic duct, and patients with sphincter of Oddi dysfunction.^[4]

Gut perforation is a risk of any endoscopic procedure, and is an additional risk if a sphincterotomy is performed. As the second part of the duodenum is anatomically in a retroperitoneal location (that is, behind the peritoneal structures of the abdomen), perforations due to sphincterotomies are also retroperitoneal. Sphincterotomy is also associated with a risk of bleeding.^[4]

Oversedation can result in dangerously low blood pressure, respiratory depression, nausea, and vomiting.

There is also a risk associated with the contrast dye in patients who are allergic to compounds containing iodine.

Other complications (less than 1 per 100) may include; heart and lung problems, bleeding after sphincterotomy, infection in the bile duct (cholangitis) and perforation (a tear in the intestine). In some rare cases, ERCP can even cause fatal complications.^[5]

References[edit]

^ Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, Qureshi W, Rajan E, Zuckerman MJ, Fanelli R, Wheeler-Harbaugh J, Faigel DO; Standards of Practice Committee of American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas.Gastrointest Endosc. 2005 Jul;62(1):1-8.
^ Farrell JJ, Bounds BC, Al-Shalabi S, Jacobson BC, Brugge WR, Schapiro RH, Kelsey PB (2005). "Single-operator duodenoscope-assisted cholangioscopy is an effective alternative in the management of choledocholithiasis not removed by conventional methods, including mechanical lithotripsy". Endoscopy 37 (6): 542–7. doi:10.1055/s-2005-861306. PMID 15933927.
^ McAlister VC, Davenport E, Renouf E (2007). "Cholecystectomy deferral in patients with endoscopic sphincterotomy". In McAlister, Vivian. Cochrane Database Syst Rev (4): CD006233. doi:10.1002/14651858.CD006233.pub2. PMID 17943900.
^ ^a ^b Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F, Pilotto A, Forlano R (2007). "Incidence rates of post-ERCP complications: a systematic survey of prospective studies". Am. J. Gastroenterol. 102 (8): 1781–8. doi:10.1111/j.1572-0241.2007.01279.x. PMID 17509029.
^ Cotton, Peter B. (2013-05-31). "ERCP (Endoscopic Retrograde Cholangio-Pancreatography) | MUSC Digestive Disease Center". Ddc.musc.edu. Retrieved 2013-06-09.

External links[edit]

MedlinePlus Encyclopedia ERCP
National Digestive Diseases Information Clearinghouse

UpToDate Contents

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1. 内視鏡的逆行性胆道膵管造影：適応、患者の準備、および合併症 endoscopic retrograde cholangiopancreatography indications patient preparation and complications
2. 内視鏡的逆行性胆管膵管造影（ERCP）後の敗血症合併症 post endoscopic retrograde cholangiopancreatography ercp septic complications
3. 内視鏡的逆行性胆管膵管造影（ERCP）後膵炎 post endoscopic retrograde cholangiopancreatography ercp pancreatitis
4. 内視鏡的逆行性胆道膵管造影（ERCP）の稀な合併症 rare complications of endoscopic retrograde cholangiopancreatography ercp
5. 内視鏡的逆行性胆管膵管造影（ERCP）後出血 post endoscopic retrograde cholangiopancreatography ercp bleeding

English Journal

Endoscopy in the elderly: risks, benefits, and yield of common endoscopic procedures.

Razavi F, Gross S, Katz S.Author information Division of Gastroenterology, Langone Medical Center, New York University, 550 1st Avenue, New York, NY 10016, USA. Electronic address: razavi.farid@gmail.com.AbstractThere has been limited research examining the risks, benefits, and use of common endoscopic procedures in the elderly. Furthermore, gastroenterology training programs do not routinely incorporate elderly concerns when dealing with common gastrointestinal issues. There exists a broad array of endoscopic procedures with varying inherent risks that must be weighed with each elderly patient in mind. This article discusses the benefits and drawbacks of the most common procedures and indications for endoscopy including upper endoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, percutaneous endoscopic gastrostomy, and deep enteroscopy.
Clinics in geriatric medicine.Clin Geriatr Med.2014 Feb;30(1):133-47. doi: 10.1016/j.cger.2013.10.010.
There has been limited research examining the risks, benefits, and use of common endoscopic procedures in the elderly. Furthermore, gastroenterology training programs do not routinely incorporate elderly concerns when dealing with common gastrointestinal issues. There exists a broad array of endosco
PMID 24267608

In vivo imaging of intestinal helminths by capsule endoscopy.

Soga K, Handa O, Yamada M, Sakagami J, Yagi N, Naito Y, Yoshikawa T, Itoh Y, Arizono N.Author information Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto 602-8566, Japan; Department of Gastroenterology, Nishijin Hospital, Kyoto 602-8319, Japan. Electronic address: sogatti@koto.kpu-m.ac.jp.AbstractThis review examines the use of digestive endoscopy to visualize intestinal helminths. The infections caused by these parasites are responsible for high levels of morbidity and mortality. These helminths can be visualized using gastroduodenal endoscopy, endoscopic retrograde cholangiopancreatography, and colonoscopy. Endoscopic examination of the small bowel is limited by its considerable length and its distance from the mouth and anus. Since capsule endoscopy (CE) was first reported in 2000, it has been established as a noninvasive modality for the investigation of the gastrointestinal tract. CE is used as a first-line tool for imaging various small-bowel diseases, mainly obscure gastrointestinal bleeding and Crohn's disease. Since the Food and Drug Administration (FDA) approved CE in 2001, the indications for its use have expanded widely. For example, CE can be used to visualize the in vivo kinetics of intestinal helminths. If the current trends in technological development continue, CE will become more widely used to facilitate the diagnosis and treatment of helminth infections in the near future.
Parasitology international.Parasitol Int.2014 Feb;63(1):221-8. doi: 10.1016/j.parint.2013.09.006. Epub 2013 Sep 17.
This review examines the use of digestive endoscopy to visualize intestinal helminths. The infections caused by these parasites are responsible for high levels of morbidity and mortality. These helminths can be visualized using gastroduodenal endoscopy, endoscopic retrograde cholangiopancreatography
PMID 24050882

Eosinophilic cholangiopathy: the diagnostic dilemma of a recurrent biliary stricture. Should surgery be offered for all?

Seow-En I, Chiow AK, Tan SS, Poh WT.Author information Department of General Surgery, Changi General Hospital, Singapore, Singapore.AbstractA 63-year-old man presented with the initial diagnosis of autoimmune pancreatitis with obstructive jaundice. CT of the abdomen revealed an oedematous pancreas and dilated common bile duct (CBD), without gallstones. After failure of initial retrograde cholangiopancreatography, a percutaneous biliary catheter was inserted with good drainage. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) revealed a 2 cm distal CBD stricture. A biliary stent was inserted past the stricture. Biopsy of the stricture, brush cytology of the bile duct and fine needle aspiration of pancreatic head under endoscopic ultrasound guidance were negative for malignancy. Autoimmune screen was negative as well. However, the patient represented with cholangitis requiring repeat ERCP and insertion of a second biliary stent. He finally underwent cholecystectomy with excision of the distal CBD and Roux-En-Y hepaticojejunostomy. Histology revealed diffuse eosinophilic cholecystitis and cholangitis. A retrospective review of the blood results showed persistent eosinophilia in full blood count measurements from presentation and persisting throughout the treatment period.
BMJ case reports.BMJ Case Rep.2014 Jan 3;2014(jan03_1). pii: bcr2013202225. doi: 10.1136/bcr-2013-202225.
A 63-year-old man presented with the initial diagnosis of autoimmune pancreatitis with obstructive jaundice. CT of the abdomen revealed an oedematous pancreas and dilated common bile duct (CBD), without gallstones. After failure of initial retrograde cholangiopancreatography, a percutaneous biliary
PMID 24390967

Japanese Journal

ショート・ワイヤーを用いた胆膵内視鏡治療 (特集患者にやさしいERCPの工夫)

中嶋哲也,川口勝輝,杉山元 [他]
消化器内科 58(4), 527-534, 2014-04
NAID 40020076786

ダブルバルーン内視鏡を用いたERCP検査中の経皮的CO₂分圧モニタリング (特集患者にやさしいERCPの工夫)

三好秀明,島谷昌明,加藤孝太 [他]
消化器内科 58(4), 522-526, 2014-04
NAID 40020076773

ERCP中のCO₂送気は処置後のみならず処置中も患者ストレスを軽減しうる (特集患者にやさしいERCPの工夫)

村木崇,渡邉貴之,児玉亮 [他]
消化器内科 58(4), 515-521, 2014-04
NAID 40020076671

Related Pictures

★リンクテーブル★

リンク元	「内視鏡的逆行性胆管膵管造影」「内視鏡的逆行性胆膵管造影」「内視鏡的逆行性胆膵管造影法」「内視鏡的逆行性胆道膵管撮影」「ERCP」
関連記事	「endoscopic」「retrograde」「cholangiopancreatography」

「内視鏡的逆行性胆管膵管造影」

Endoscopic retrograde cholangiopancreatography
	Intervention
	; Duodenoscopic image of two pigment stones extracted from common bile duct after sphincterotomy.
ICD-9-CM	51.10
MeSH	D002760
OPS-301 code:	1-642

　　[★]

英: endoscopic retrograde cholangiopancreatography, ERCP
同: 内視鏡的逆行性膵胆管造影、内視鏡的逆行性膵胆管造影法、内視鏡的逆行性胆管膵管造影、内視鏡的逆行性胆管膵管造影法
関: 内視鏡的胆道ドレナージ

[show details]

内視鏡的逆行性膵胆管造影法 : 約 2,250 件
内視鏡的逆行性膵胆管造影 : 約 33,400 件
内視鏡的逆行性胆管膵管造影法 : 約 13,800 件
内視鏡的逆行性胆管膵管造影 : 約 36,300 件
endoscopic retrograde cholangiopancreatography : 約 120,000 件
endoscopic retrograde cholangio-pancreatography : 約 27,000 件
endoscopic retrograde cholangiopancreagraphy : 4 件

概念

胆道疾患の診断目的に施行する画像検査
内視鏡を用いて、十二指腸乳頭部から膵管および胆管内に細径チューブを挿入し、造影剤を注入して撮像すること。

禁忌

全身状態が著しく不良
造影剤過敏症(アナフィラキシーショック)
急性膵炎急性期
慢性膵炎の急性増悪期

参考

http://www.pariet.jp/alimentary/clinicalpath/clipathrep01-k05-01.html

	適応	禁忌	要注意
膵臓疾患	・膵臓癌・嚢胞性疾患・慢性膵炎・膵管癒合不全・輪状膵	・全身状態が著しく不良・造影剤過敏症（アナフィラキシーショック）・急性膵炎急性期・慢性膵炎の急性増悪期	・上部消化管狭窄・胃全摘出後　 Roux-en-Y吻合・Billroth II法　残胃例
胆道疾患	・胆管癌・胆嚢癌・胆道結石症・胆管狭窄・膵・胆管合流異常
乳頭部疾患	・乳頭部癌・乳頭機能不全症

-ERCP

「内視鏡的逆行性胆膵管造影」

　　[★]

英: endoscopic retrograde cholangiopancreatography
関: 内視鏡的逆行性胆管膵管造影、内視鏡的逆行性胆道膵管撮影、内視鏡的逆行性胆膵管造影法

「内視鏡的逆行性胆膵管造影法」

　　[★]

英: endoscopic retrograde cholangiopancreatography
関: 内視鏡的逆行性胆管膵管造影、内視鏡的逆行性胆道膵管撮影、内視鏡的逆行性胆膵管造影

「内視鏡的逆行性胆道膵管撮影」

　　[★]

英: endoscopic retrograde cholangiopancreatography
関: 内視鏡的逆行性胆管膵管造影、内視鏡的逆行性胆膵管造影、内視鏡的逆行性胆膵管造影法

「ERCP」

　　[★] 内視鏡的逆行性胆管膵管造影 endoscopic retrograde cholangiopancreatography

「endoscopic」

　　[★]

adj.

内視鏡的な、内視鏡下での、内視鏡検査の

関: endoscopic screening、endoscopically、endoscopy

「retrograde」

　　[★]

逆行性の、逆行型の、逆向性の、逆方向性の

関: antidromic、retrogradely

「cholangiopancreatography」

　　[★]

胆管膵臓造影、胆管膵臓造影法

[1] Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, Qureshi W, Rajan E, Zuckerman MJ, Fanelli R, Wheeler-Harbaugh J, Faigel DO; Standards of Practice Committee of American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas.Gastrointest Endosc. 2005 Jul;62(1):1-8.

[pmid15933927-2] Farrell JJ, Bounds BC, Al-Shalabi S, Jacobson BC, Brugge WR, Schapiro RH, Kelsey PB (2005). "Single-operator duodenoscope-assisted cholangioscopy is an effective alternative in the management of choledocholithiasis not removed by conventional methods, including mechanical lithotripsy". Endoscopy 37 (6): 542–7. doi:10.1055/s-2005-861306. PMID 15933927.

[3] McAlister VC, Davenport E, Renouf E (2007). "Cholecystectomy deferral in patients with endoscopic sphincterotomy". In McAlister, Vivian. Cochrane Database Syst Rev (4): CD006233. doi:10.1002/14651858.CD006233.pub2. PMID 17943900.

[pmid17509029-4] Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F, Pilotto A, Forlano R (2007). "Incidence rates of post-ERCP complications: a systematic survey of prospective studies". Am. J. Gastroenterol. 102 (8): 1781–8. doi:10.1111/j.1572-0241.2007.01279.x. PMID 17509029.

[5] Cotton, Peter B. (2013-05-31). "ERCP (Endoscopic Retrograde Cholangio-Pancreatography) | MUSC Digestive Disease Center". Ddc.musc.edu. Retrieved 2013-06-09.

匿名

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案内

endoscopic retrograde cholangiopancreatography