Diagnostic endoscopic retrograde cholangiopancreatography

Since the introduction of magnetic resonance cholangiopancreatography (MRCP), the focus in endoscopic retrograde cholangiopancreatography (ERCP) has shifted from diagnosis to treatment - a change that has organizational implications in relation to teaching and providing access to ERCP. Most of last year's papers on ERCP described refinements of the technique and indication, tissue sampling, and efforts to reduce complications. Many studies compared MRCP with various other imaging methods and with histopathological findings. Bile duct stones and strictures are still the main target, but new entities for evaluation with MRCP have been found: primary sclerosing cholangitis, choledochal cysts, chronic pancreatitis, pancreatic injury, and postop operative abnormalities. Helical computed-tomographic cholangiography is still attracting some interest. This review closes with a comparison of ERCP with MRCP with regard to availability, legal aspects, operator-dependency, and cost-effectiveness.