Jaundice After the advent of MDCT in the late 1990s, which allowed for improved spatial resolution as low as 0.6-mm slice thickness and isotropic reconstructions in multiple planes, several articles showed that MDCT sensitivity for the presence of biliary obstruction improved to >90% [37-39]. MDCT of 64-slice and higher using minimum- intensity projection and multiplanar reconstructions has excellent spatial resolution and accuracy for staging of biliary malignancies and helps differentiate benign from malignant strictures [37,106-109]. ERCP ERCP is an invasive procedure that is typically performed by gastroenterologists or general surgeons in an interventional suite or operating room under general anesthesia and requires advancing an endoscope into the duodenum, with cannulation of the ampulla and injection of contrast into the CBD with fluoroscopic images obtained to image the biliary tree. ERCP may be performed with a concomitant sphincterotomy, biopsy, or stent deployment (CBD or pancreatic). ERCP is the most commonly performed invasive diagnostic and therapeutic biliary procedure. Because of significant advances in cross-sectional imaging, in particular the advent of MRCP, ERCP currently has an almost exclusively therapeutic role [65-67]. In the setting of suspected biliary obstruction, particularly if there is high concern for CBD stones or malignant obstruction, ERCP may be performed as the initial diagnostic and therapeutic imaging modality [68]. ERCP is very sensitive for detecting biliary ductal calculi [26,53]. However, as an interventional procedure, ERCP has a risk of between 4% (111 of 2,769) to 5.2% (872 of 16,855) for major complications (pancreatitis, cholangitis, hemorrhage, and perforation), with a 0.4% (11 of 2,769) mortality risk [69,70]. These factors need to be weighed against the potential benefits of ERCP [53,68,71,72]. The main indication for ERCP remains management of CBD stones, which can be cleared in 80% to 95% of cases with a balloon sweep of the CBD [71,73].
Jaundice. Jaundice After the advent of MDCT in the late 1990s, which allowed for improved spatial resolution as low as 0.6-mm slice thickness and isotropic reconstructions in multiple planes, several articles showed that MDCT sensitivity for the presence of biliary obstruction improved to >90% [37-39]. MDCT of 64-slice and higher using minimum- intensity projection and multiplanar reconstructions has excellent spatial resolution and accuracy for staging of biliary malignancies and helps differentiate benign from malignant strictures [37,106-109]. ERCP ERCP is an invasive procedure that is typically performed by gastroenterologists or general surgeons in an interventional suite or operating room under general anesthesia and requires advancing an endoscope into the duodenum, with cannulation of the ampulla and injection of contrast into the CBD with fluoroscopic images obtained to image the biliary tree. ERCP may be performed with a concomitant sphincterotomy, biopsy, or stent deployment (CBD or pancreatic). ERCP is the most commonly performed invasive diagnostic and therapeutic biliary procedure. Because of significant advances in cross-sectional imaging, in particular the advent of MRCP, ERCP currently has an almost exclusively therapeutic role [65-67]. In the setting of suspected biliary obstruction, particularly if there is high concern for CBD stones or malignant obstruction, ERCP may be performed as the initial diagnostic and therapeutic imaging modality [68]. ERCP is very sensitive for detecting biliary ductal calculi [26,53]. However, as an interventional procedure, ERCP has a risk of between 4% (111 of 2,769) to 5.2% (872 of 16,855) for major complications (pancreatitis, cholangitis, hemorrhage, and perforation), with a 0.4% (11 of 2,769) mortality risk [69,70]. These factors need to be weighed against the potential benefits of ERCP [53,68,71,72]. The main indication for ERCP remains management of CBD stones, which can be cleared in 80% to 95% of cases with a balloon sweep of the CBD [71,73].