BILIARY ENDOSCOPY

The diagnostic role of endoscopic retrograde cholangiopancreatography (ERCP) is improved by the use of brushing, according to samples analys is by flow cytometry, cell image analysis, or even molecular biology. Prevention of complications requires high expertise levels and ERCP sh ould not be performed if it cannot be followed by the appropriate endo scopic therapy for logistic reasons. At present, it is clearly the fir st choice technique for treatment of gallstone pancreatitis, common bi le duct (CBD) stones, treatment of benign biliary stricture, or pallia tion of biliopancreatic malignancies. The respective roles of classic and self-expanding metal stents are becoming more precise and new mate rials are still in development that might improve the long-term patenc y of the stents. Laparoscopic cholecystectomy is associated with an in crease of postoperative CBD injuries and ERCP plays a major role in th eir management. The incidence of biliary injuries could be reduced by an optimization of surgical and endoscopic collaboration, limiting the necessity of perioperative approach to the CBD. Techniques like endos copic ultrasonography or magnetic nuclear resonance could replace stri ctly diagnostic ERCP in selected situations.