ERCP is an endoscopic procedure that requires a good understanding of the anatomy of the bilio-pancreatic region and the use of dedicated accessories and instruments. The main difference from conventional endoscopic techniques is the use of a dedicated side viewing endoscope (duodenoscope) in conjunction with an X-ray machine. Intubation of the duodenum with a duodenoscope and achieving a stable position in front of the papilla major require a different set of maneuvers from the common intubation of the duodenum using a forward viewing scope. The use of torque is especially important, as is a correct understanding of anatomical landmarks in the region. The papilla is usually found in the second portion of the duodenum but many anatomical variants, including intra-diverticular papillas, are possible. After identification of the papilla, access to the bilio-pancreatic ducts is carried out using a variety of techniques and devices, including (but not limited to) a sphincterotome preloaded with a guidewire and capable of contrast injection. Access to the desired duct is usually followed by a variety of therapeutic maneuvers (stone extraction, placement of stents, stricture dilatation). 

Lecture during Nov 19 session.

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