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Old 04-07-2011
Haisook's Avatar
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Question When is ERCP the initial test?

When is ERCP the initial test to do?
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Old 04-08-2011
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Arrow ERCP

Hi Haisook,
ERCP is never the initial test for anything! It is invasive and not cheap so never initial. If I would choose closest to initial will be in:
Primary Sclerosing Cholangitis ( if you have a pruiritic, middle age, woman, with increase ALP ---> do antimitochondrial Antibody if negative---> then to DX. Most specific test is ERCP (so technically initial imaging)

other improtant uses:
-Pancreatic Ca---> initial is CT---> if tumor not seen---> ERCP
-Gallbladder Ca--->initial is US---> if +(calcification) then---> ERCP to localize & biopsy
-Acute Cholecystitis ---> if patient not stable for surgery---> ERCP for delivery of stone solvent.
-Choledocholithiasis---> initial US if negative but high suspicion based on Hx and persentation---> Biliary scientigraphy--> if still negative and no stone then---> EGD (to check for ulcer) if no ulcer---> ERCP (to differentiate between Choledocholithiasis & biliary Dyskynesia)

Hope this help
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