Technique

Side viewing endoscope introduced perorally into the duodenum

Ampulla of Vater is visualized and catheter advanced through ampulla

Injection of dye allows visualization of common bile duct and pancreatic duct

Success rate of cannulation of common bile duct

80-95% depending on operator’s skill

Therapeutic interventions

Removal of common bile duct stones

Placement of stents

In patients in whom ERCP is unsuccessful

imaging the bile and pancreatic ducts

It has replaced ERCP as the initial diagnostic test in cases where the need for
intervention is felt to be small

DIAGNOSTIC PROCEDURES

Percutaneous liver biopsy

Only indicated when confronted with hepatocellular disease of unknown type

Histologic findings

Hepatitis B and C can cause cholestatic hepatitis (fibrosing cholestatic hepatitis), which
has histologic features that mimic large duct obstruction

Vanishing bile duct syndrome and adult bile ductopenia

Decreased number of bile ducts seen in liver biopsy specimens

Histologic picture similar to that found in primary biliary cirrhosis

Intrahepatic cholestasis
Diagnosis often made by serologic testing in combination with percutaneous liver
biopsy

DIFFERENTIAL DIAGNOSIS

Other causes of yellowing of skin

Carotenoderma

Yellow color is imparted to skin by presence of carotene

Occurs in healthy individuals who ingest excessive amounts of vegetable and fruits