Endoscopic Retrograde Cholangiopancreatography (ERCP)-as a Diagnostic Technique in Pancreatobiliary System and its Comparison with Abdominal Ultrasound. (An experience with 50 patients)

Abstract

Obstructive jaundice is a fairly common ailment. For the proper management of obstructive jaundice it is essential that one should know the cause of obstruction. Abdominal ultrasonography and ERCP are the most commonly employed modalities of diagnosis in such cases. This study was carried out to evaluate and compare the diagnostic yield of these two tests in patients suspected to have obstructive jaundice. A total number of 50 patients including 29 females and 21 males were enrolled for study. All patients were subjected to abdominal ultrasonography and ERCP. Abdominal ultrasound was able to determine the cause of obstruction in 17(34%) patients. Biliary calculi were the commonest cause of obstruction, present in 12(24%) patients, followed by carcinoma of the gall bladder and common bile duct (CBD) malignancy, found in 3(6%) and 2(4%) patients respectively. In 33(66%) patients ultrasound only showed dilatation of the hepatobiliary passages without any definite cause of obstruction. On the contrary, ERCP was able to find the cause of obstruction in 47 (94%) patients. The commonest cause of obstruction again was the biliary calculi, found in 21 (42%) patients, followed by malignancy in 19(38%) patients, comprising of 10(20%) cases of ampullary carcinoma, 6(12%) cases of cholangiocarcinoma and 3(6%) cases of gall bladder carcinoma. Three (6%) patients were found to have benign strictures of CBD. One (2%) patient was found to have cost-surgical metal clip and another one (2%) was found to have Caroli’s disease. In 1(2%) patient no cause of obstruction was found even on ERCP and 2(4%) patients could not be cannulated. Therefore, it is obvious that although a difficult procedure, ERCP is diagnostic in more number of cases of obstructive jaundice as compared to abdominal ultrasound. Hence, it is recommended that ERCP should be performed in patients where ultrasound is non-diagnostic and in patients where exact details regarding obstruction are required. Moreover, ERCP should be performed where ever some therapeutic endoscopic procedure is contemplated.