Guideline sources The following summarized guidelines for the evaluation and management of endoscopic retrograde cholangiopancreatography are prepared by our editorial team based on guidelines from the American Society for Gastrointestinal Endoscopy (ASGE 2023; 2021; 2019; 2017; 2016; 2015), the American Association for the Study of Liver Diseases (AASLD 2022), the European Society of Gastrointestinal Endoscopy (ESGE 2020; 2019; 2016), the World Society of Emergency Surgery (WSES 2020; 2019), the British Society of Gastroenterology (BSG 2019; 2017), the World Society of Emergency Surgery (WSES/AAST 2019), the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN 2018), the American Gastroenterological Association (AGA 2018), the INternational Study Group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE 2017), the Canadian Best Practice in General Surgery Group (BPIGS 2016), the European Association for the Study of the Liver (EASL 2016), and the American College of Gastroenterology (ACG 2015; 2013). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 https://web.pathway.md/diseases/reckikcucSpfA7am4 1/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway Calculator Calculator Calculat ASGE/SAGES criteria for stratific Diagnostic criteria for acute pan Glasgo Guidelines 1. Classification and risk stratification Risk factors for complications: Consider regarding patients as being at high risk for post- ERCP pancreatitis in the presence of at least one definite or two likely patient-related or procedure-related risk factors: Situation Guidance Female gender, previous pancreatitis, previous post-ERCP pancreatitis, suspected sphincter of Oddi dysfunction Patient-related definite risk factors Difficult cannulation Procedure-related definite risk factors Pancreatic guidewire passages > 1 Pancreatic injection Younger age Patient-related likely risk factors Nondilated extrahepatic bile duct Absence of chronic pancreatitis Normal serum bilirubin End-stage renal disease Precut sphincterotomy Procedure-related likely risk factors Pancreatic sphincterotomy Biliary balloon sphincter dilation Failure to clear bile duct stones Intraductal ultrasound. C Show 3 more 2. Diagnostic investigations Coagulation studies: avoid obtaining coagulation tests routinely before ERCP in patients not on anticoagulants and without jaundice. D 3. Diagnostic procedures https://web.pathway.md/diseases/reckikcucSpfA7am4 2/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway Diagnostic indications, pancreatobiliary pain: do not perform diagnostic ERCP for the evaluation of pancreaticobiliary-type pain in the absence of objective abnormalities on other pancreaticobiliary imaging or laboratory studies. D Diagnostic indications, acute pancreatitis: As per AGA 2018 guidelines, avoid performing urgent ERCP routinely in patients with acute biliary pancreatitis and no cholangitis. D As per ACG 2013 guidelines, limit the use of endoscopic investigations in patients with acute idiopathic pancreatitis because of unclear risks and benefits. B Diagnostic indications, choledocholithiasis: perform preoperative ERCP, intraoperative cholangiography, or laparoscopic ultrasound, depending on the local expertise and the availability of the technique, in patients at high risk for common bile duct stones. A Diagnostic indications, primary sclerosing cholangitis: As per AASLD 2022 guidelines, avoid performing ERCP for the diagnosis of PSC. D Show 2 more As per BSG 2019 guidelines: Consider performing ERCP in patients with suspected primary sclerosis cholangitis and biliary strictures requiring tissue acquisition (such as cytological brushings) or when therapeutic intervention is indicated. Perform pathological sampling of suspicious strictures in patients undergoing ERCP for dominant strictures. B Avoid performing ERCP in patients with PSC until an expert multidisciplinary assessment is available justifying endoscopic intervention. D As per ACG 2015 guidelines, perform ERCP (with cytology, biopsies, and fluorescence in- situ hybridization) to exclude cholangiocarcinoma in patients with a dominant stricture on imaging. B Diagnostic indications, biliary strictures: consider performing peroral cholangioscopy with directed biopsy as an adjunctive technique for characterizing indeterminate biliary strictures. C Diagnostic indications, pancreatobiliary trauma: consider performing ERCP for both diagnosis and treatment in hemodynamically stable or stabilized adult and pediatric patients with suspected pancreatic duct and extrahepatic biliary tree injuries, even in the early phase after trauma. B Diagnostic indications, pancreatic tumors (cystic lesions): consider performing ERCP for the diagnosis and characterization of suspected main duct intraductal papillary mucinous neoplasms. C Diagnostic indications, pancreatic tumors (solid lesions): do not perform preoperative ERCP in patients with obstructive jaundice due to resectable adenocarcinoma of the pancreas in the absence of cholangitis, unless a substantial delay in operative resection of a symptomatic patient is anticipated. D Diagnostic indications, before laparoscopic cholecystectomy: do not perform routine ERCP before laparoscopic cholecystectomy in the absence of objective signs of biliary obstruction or stone. D https://web.pathway.md/diseases/reckikcucSpfA7am4 3/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway 4. Medical management Management of bleeding: Consider administering local injection of epinephrine (1:10, 000), possibly combined with thermal or mechanical therapy when injection alone fails, for the management of persistent or delayed post-sphincterotomy bleeding. C Consider performing temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities. C Management of perforation: consider providing nonoperative management in patients with suspected periampullary or instrument-related perforations from ERCP without evidence of peritonitis or systemic inflammatory response syndrome. C Management of cholangitis: consider obtaining abdominal ultrasound or CT in patients with post-ERCP cholangitis with no improvement with conservative therapy, to consider repeat ERCP cholangitis. Collect a bile sample for microbiological examination during repeat ERCP. C Management of pancreatitis: Consider testing serum amylase and/or lipase 2-6 hours after ERCP in patients with postprocedural abdominal pain planned to be discharged on the day of ERCP. Consider discharging patients with serum amylase and lipase values < 1.5 and 4 times the ULN, respectively, without concerns about the development of post-ERCP pancreatitis. C Avoid performing salvage pancreatic stenting in patients with post-ERCP pancreatitis. D 5. Therapeutic procedures Therapeutic indications, acute cholangitis: As per ASGE 2021 guidelines: Consider performing ERCP over percutaneous transhepatic biliary drainage in patients with cholangitis. C Consider performing ERCP within 48 hours after admission. C As per ESGE 2019 guidelines, perform endoscopic biliary drainage in patients with acute cholangitis, with timing depending on the severity of cholangitis: Situation Guidance As soon as possible and within 12 hours in patients with septic shock Severe Within 48-72 hours Moderate Elective. B Mild As per EASL 2016 guidelines, perform ERCP with sphincterotomy and stone extraction in patients with biliary pancreatitis with suspected coexistent acute cholangitis, with timing depending on the severity of cholangitis but preferably within 24 hours. A Show 2 more https://web.pathway.md/diseases/reckikcucSpfA7am4 4/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway Therapeutic indications, choledocholithiasis, general indications: As per ASGE 2019 guidelines, perform prompt ERCP in patients with the following high-risk criteria for choledocholithiasis: common bile duct stone on ultrasound or cross-sectional imaging TBIL > 4 mg/dL and dilated common bile duct ascending cholangitis. E Show 2 more As per BSG 2017 guidelines, perform ERCP in patients with common bile duct stones requiring endoscopic therapy. B Therapeutic indications, choledocholithiasis, technical considerations: As per ESGE 2019 guidelines, provide adequate exit for the stones that are to be removed, according to the papilla and common bile duct anatomy and the stone size. B Show 6 more As per BSG 2017 guidelines, recognize that tolerability and likelihood of therapeutic success are higher in selected patients when ERCP is performed with propofol sedation or general anesthesia. Ensure that hospitals managing patients with common bile duct stones have ready and prompt access to anesthesia-supported ERCP, either as an on-site service or provided by another ERCP unit as part of a clinical network. B Therapeutic indications, choledocholithiasis, cholangioscopic interventions: As per ESGE 2019 guidelines, perform cholangioscopy-assisted intraluminal lithotripsy (electrohydraulic or laser) for the treatment of difficult bile duct stones. B As per ASGE 2015 guidelines, consider performing cholangioscopy as an adjunctive technique for the management of difficult bile duct stones not amenable to removal after sphincterotomy with or without balloon dilation or mechanical lithotripsy. C Therapeutic indications, choledocholithiasis (post-ERCP cholecystectomy): perform laparoscopic cholecystectomy within 2 weeks from ERCP in patients treated for choledocholithiasis, to reduce the conversion rate and the risk of recurrent biliary events. B Therapeutic indications, acute pancreatitis: As per WSES 2019 guidelines, do not perform routine ERCP in patients with acute gallstone pancreatitis. D Show 2 more As per BPIGS 2016 guidelines: Perform ERCP within 24-48 hours in patients with acute gallstone pancreatitis associated with bile duct obstruction or cholangitis. B Perform ERCP with sphincterotomy before discharge in patients with acute gallstone pancreatitis, if cholecystectomy cannot be performed during the index admission because of medical comorbidities. B As per ASGE 2015 guidelines, perform ERCP in patients with acute biliary pancreatitis with concomitant cholangitis or biliary obstruction. A As per ACG 2013 guidelines: Perform ERCP within 24 hours of admission in patients with acute pancreatitis and concurrent acute cholangitis. B https://web.pathway.md/diseases/reckikcucSpfA7am4 5/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway Avoid performing ERCP in patients with gallstone pancreatitis in the absence of laboratory or clinical evidence of ongoing biliary obstruction. D Therapeutic indications, sphincter of Oddi dysfunction: perform ERCP with sphincterotomy in patients with type I sphincter of Oddi dysfunction. B Show 2 more Therapeutic indications, primary sclerosing cholangitis: perform ERCP with dilation and stent placement in patients with benign biliary strictures. B Therapeutic indications, postoperative biliary leaks: perform ERCP as first-line therapy for postoperative biliary leaks. A 6. Specific circumstances Pediatric patients: As per NASPGHAN 2018 guidelines, perform ERCP for the management of acute pancreatitis related to choledocholithiasis causing biliary pancreatitis, and for pancreatic duct pathologies, such as ductal stones or ductal leaks. E As per INSPPIRE 2017 guidelines, consider performing ERCP or EUS, depending on the clinical scenario, as an alternative to MRCP in patients with acute recurrent pancreatitis. B Pregnant patients (general principles): recognize that therapeutic ERCP is a safe and effective procedure in pregnant patients, provided that it is performed by experienced endoscopists and the radiation exposure to the fetus is kept as low as possible. B Pregnant patients (prevention of post-ERCP pancreatitis): do not administer NSAIDs for post-ERCP pancreatitis prophylaxis in pregnant patients at 30-week gestation. D Patients with altered anatomy: perform ERCP in patients with Billroth II gastrectomy in referral centers, with the side-viewing endoscope as a first option, and forward-viewing endoscopes (gastroscope, pediatric colonoscope, and balloon enteroscope) as the second choice in cases of failure. B Show 4 more 7. Patient education Informed consent: obtain both oral and written informed consent before ERCP, taking into account individual and procedure-related risks, correct indication, and urgency of ERCP, as well as national practice. B 8. Preventative measures Prevention of pancreatitis, proceduralist expertise: As per ASGE 2017 guidelines, ensure that clinicians performing performing ERCP are facile with procedural techniques reducing the risk of pancreatitis (wire-guided cannulation, prophylactic pancreatic duct stenting). A https://web.pathway.md/diseases/reckikcucSpfA7am4 6/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway As per BSG 2017 guidelines, provide training and subsequent mentorship to ensure competency in access papillotomy in all endoscopists performing ERCP. B Prevention of pancreatitis, rectal NSAIDs: As per ASGE 2023 guidelines, administer periprocedural rectal NSAIDs for the prevention of post-ERCP pancreatitis in unselected and high-risk patients undergoing ERCP. B As per ESGE 2020 guidelines, administer rectal diclofenac or indomethacin at a dose of 100 mg immediately before ERCP in all patients without contraindications to NSAID administration. B Show 2 more As per ASGE 2017 guidelines, administer rectal NSAIDs to reduce the incidence and severity of post-ERCP pancreatitis in high-risk patients without contraindication. B Show 2 more As per BSG 2017 guidelines, administer 100 mg of diclofenac or indomethacin rectally at the time of ERCP to reduce the risk of post-ERCP pancreatitis in all patients without contraindications to NSAIDs. B As per ACG 2013 guidelines, administer postprocedural rectal NSAID suppositories to prevent severe pancreatitis after ERCP in high-risk patients. B Prevention of pancreatitis, IV fluids: As per ASGE 2023 guidelines, consider administering aggressive periprocedural and postprocedural IV hydration to prevent post-ERCP pancreatitis in unselected patients undergoing ERCP. C As per ESGE 2020 guidelines, administer aggressive hydration with lactated Ringer's solution (3 mL/kg/hour during ERCP, 20 mL/kg bolus after ERCP, 3 mL/kg/hour for 8 hours after ERCP) in patients with contraindication to NSAIDs, provided that they are not at risk of fluid overload and that a prophylactic pancreatic duct stent is not placed. B As per ASGE 2017 guidelines, consider administering periprocedural IV hydration with lactated Ringer's solution when feasible to decrease the risk of post-ERCP pancreatitis. C Prevention of pancreatitis (sublingual nitrates): consider administering 5 mg sublingual glyceryl trinitrate before ERCP for the prevention of post-ERCP pancreatitis in patients with contraindications to NSAIDs or to aggressive hydration. C Prevention of pancreatitis (epinephrine): do not administer epinephrine topically onto the papilla for post-ERCP pancreatitis prophylaxis. D Prevention of pancreatitis (protease inhibitors): do not use protease inhibitors for post- ERCP pancreatitis prophylaxis. D Prevention of pancreatitis, pancreatic stenting: As per ASGE 2023 guidelines: Perform pancreatic duct stenting to reduce the risk of post-ERCP pancreatitis in patients undergoing ERCP with repeated or deep pancreatic duct access or performance of ampullectomy. B Consider performing pancreatic duct stenting in high-risk groups, including patients with difficult cannulation, history of post-ERCP pancreatitis, or precut sphincterotomy without fistulotomy technique, as long as pancreatic duct access can be easily achieved. C https://web.pathway.md/diseases/reckikcucSpfA7am4 7/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway As per ESGE 2020 guidelines: Perform prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guide-wire insertion/opacification of the pancreatic duct, double- guidewire cannulation). B Consider using a short 5-Fr pancreatic stent with no internal flange but having a flange or a pigtail on the duodenal side. Assess for the passage of the stent from the pancreatic duct within 5-10 days of placement and remove retained stents endoscopically. C As per ASGE 2017 guidelines, perform pancreatic duct stenting to reduce the incidence and severity of post-ERCP pancreatitis in high-risk patients. A As per BSG 2017 guidelines, consider performing pancreatic stenting, in addition to rectal administration of an NSAID, in patients at high risk of post-ERCP pancreatitis arising from repeated pancreatic duct cannulation. C As per ACG 2013 guidelines, perform pancreatic duct stenting to prevent severe pancreatitis after ERCP in high-risk patients. B Prevention of pancreatitis (primary biliary cannulation): consider performing wire-guided cannulation over contrast-guided cannulation to minimize the risk of post-ERCP pancreatitis in unselected patients undergoing ERCP. C Prevention of pancreatitis (difficult biliary cannulation, definition): Consider defining difficult biliary cannulation by the presence of 1 of the following: > 5 contacts with the papilla whilst attempting to cannulate > 5 minutes spent attempting to cannulate following visualization of the papilla > 1 unintended pancreatic duct cannulation or opacification. C Prevention of pancreatitis (difficult biliary cannulation, contrast- or guidewire-assisted cannulation): Perform guidewire-assisted cannulation for primary biliary cannulation to reduce the risk of post-ERCP pancreatitis. B Consider using a hydrophilic (tipped) guidewire for biliary cannulation to help achieve successful cannulation. C Prevention of pancreatitis (difficult biliary cannulation, pancreatic guidewire-assisted cannulation): perform pancreatic guidewire-assisted biliary cannulation in case of difficult biliary cannulation or repeated unintentional access to the main pancreatic duct. B Show 2 more Prevention of pancreatitis, difficult biliary cannulation, precut sphincterotomy: As per ASGE 2017 guidelines, perform early precut sphincterotomy for difficult biliary cannulation when expertise is available. B As per ESGE 2016 guidelines, perform needle-knife fistulotomy as the preferred technique for precutting. B Show 2 more Prevention of pancreatitis (difficult biliary cannulation, transpancreatic biliary sphincterotomy): Consider performing transpancreatic biliary sphincterotomy in patients with a small, difficult- to-cannulate papilla if unintentional insertion of a guidewire into the pancreatic duct occurs. https://web.pathway.md/diseases/reckikcucSpfA7am4 8/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway B Consider performing prophylactic pancreatic stenting in patients with a history of transpancreatic sphincterotomy. B Prevention of pancreatitis (difficult biliary cannulation, periampullary diverticulum): Consider performing pancreatic duct stenting followed by precut sphincterotomy or needle- knife fistulotomy, depending on the patient's anatomy and operator's experience, to achieve cannulation in patients with periampullary diverticulum and difficult cannulation. C Consider performing a small endoscopic sphincterotomy combined with endoscopic papillary balloon dilation or endoscopic papillary balloon dilation alone to facilitate large stone removal in cases where endoscopic sphincterotomy is technically difficult to complete as a result of a periampullary diverticulum. C Prevention of pancreatitis (difficult biliary cannulation, cannulation and sphincterotomy of the minor papilla): consider administering secretin injection, which can be preceded by methylene blue spray in the duodenum, when cannulation of the minor papilla is difficult. C Show 2 more Prevention of pancreatitis, endoscopic papillary balloon dilation: As per ASGE 2017 guidelines, do not perform endoscopic papillary large balloon dilation of an intact sphincter rather than endoscopic sphincterotomy with or without adjunct balloon sphincteroplasty to facilitate biliary stone extraction in patients without coagulopathy because of the increased risk of pancreatitis. Perform dilation > 1 minute if endoscopic papillary large balloon dilation alone is used. D As per ESGE 2016 guidelines, consider performing endoscopic papillary balloon dilation as an alternative to endoscopic sphincterotomy for extracting common bile duct stones < 8 mm in patients without anatomical or clinical contraindications (such as acute pancreatitis, acute cholangitis, or precut sphincterotomy), especially in the presence of coagulopathy or altered anatomy. B Show 2 more Prevention of pancreatitis, rendezvous ERCP: As per ESGE 2020 guidelines, consider performing intraoperative rendezvous ERCP for common bile duct stone extraction in patients scheduled for cholecystectomy. B As per ESGE 2019 guidelines, consider performing intraoperative rendezvous ERCP in patients with common bile duct stones undergoing cholecystectomy. C As per ESGE 2016 guidelines: Consider performing intraoperative ERCP with laparoendoscopic rendezvous, where local expertise and conditions allow, in patients with choledocholithiasis scheduled for elective cholecystectomy. C Consider performing anterograde guidewire insertion either by a percutaneous or EUS- guided approach, depending on local expertise and facilities, to achieve biliary access when biliary cannulation is unsuccessful with a standard retrograde approach. C Prevention of bleeding, sphincterotomy: As per ESGE 2020 guidelines, avoid performing routine endoscopic biliary sphincterotomy before the insertion of a single plastic or uncovered/partially covered self-expandable metallic stent for relief of biliary obstruction. D https://web.pathway.md/diseases/reckikcucSpfA7am4 9/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway As per ASGE 2017 guidelines, perform sphincterotomy selectively in patients at high-risk for bleeding. B As per ESGE 2016 guidelines, do not perform routine biliary sphincterotomy in patients undergoing pancreatic sphincterotomy, reserving it for patients with evidence of coexisting bile duct obstruction or biliary sphincter of Oddi dysfunction. D Prevention of bleeding, electrosurgical current mode: As per ASGE 2017 guidelines, use a microprocessor-controlled generator with mixed current for sphincterotomy, to reduce the risk of post-sphincterotomy bleeding. B As per ESGE 2016 guidelines: Use mixed current rather than pure cut current alone for sphincterotomy, to decrease the risk of bleeding. B Consider using a current mode providing alternating cutting and coagulation phases instead of conventional blended current, to reduce episodes of uncontrolled cutting ("zippers") and the risk of bleeding at the time of sphincterotomy. C Prevention of infection, antibiotic prophylaxis: As per AASLD 2022 guidelines, administer antimicrobial prophylaxis in the periprocedural period in patients with PSC undergoing ERCP. E As per ESGE 2020 guidelines: Do not administer routine antibiotic prophylaxis before ERCP. D Consider administering antibiotic prophylaxis (with an agent active against Gram-negative bacteria and adapted as much as possible to local epidemiology) before ERCP in case of anticipated incomplete biliary drainage, in severely immunocompromised patients, and when performing cholangioscopy. C As per BSG 2019 guidelines, administer antibiotics prophylaxis in patients with suspected PSC undergoing ERCP. B As per ESGE 2019 guidelines, avoid administering routine antibiotic prophylaxis before ERCP for bile duct stones. D As per ASGE 2017 guidelines, administer antibiotic prophylaxis (with an agent covering biliary flora, such as enteric Gram-negative organisms and enterococci) before ERCP in patients undergone liver transplantation or when there is a possibility of incomplete biliary drainage, and continued after the procedure if biliary drainage is incomplete. B As per ACG 2015 guidelines, administer antibiotic prophylaxis in patients with PSC undergoing ERCP to prevent post-ERCP cholangitis. B Prevention of infection (duodenoscope reprocessing): ensure strict compliance with current manufacturer protocols and U.S. FDA recommendations for duodenoscope reprocessing to limit duodenoscope-related transmission of infections. A Prevention of contrast allergy: avoid administering premedication for the prevention of contrast media allergy during ERCP in patients with a history of food or IV contrast allergies. D 9. Quality improvement https://web.pathway.md/diseases/reckikcucSpfA7am4 10/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway Quality indicators (preprocedural): Record and document the frequencies of the following as preprocedural quality indicators for ERCP: endoscopy is performed for an indication included in a published standard list of appropriate indications B informed consent is obtained B preprocedure history is elicited and directed physical examination is performed B risk for adverse events is assessed before sedation B prophylactic antibiotics are administered only in selected settings where indicated B a sedation plan is documented B management of antithrombotic therapy is formulated in print before the procedure B a team pause is conducted B endoscopy is performed by a specialist fully trained and credentialed to perform that particular procedure. B Quality indicators (intraprocedural): Record and document the frequencies of the following as intraprocedural quality indicators for ERCP: photodocumentation is performed monitoring in patients receiving sedation is obtained the doses and routes of administration of all medications used during the procedure are documented use of reversal agents is documented procedure interruption and premature termination because of oversedation or airway management issues is documented. B Quality indicators (postprocedural): Record and document the frequencies of the following as postprocedural quality indicators for ERCP: discharge from the endoscopy unit according to predetermined discharge criteria is documented patient instructions are provided the plan for pathology follow-up is specified a complete procedure report is created immediate adverse events requiring interventions are documented immediate adverse events requiring interventions including hospitalization occur delayed adverse events leading to hospitalization or additional procedures or medical interventions occur within 14 days patient satisfaction data are obtained communication with referring providers is documented. B References 1. Chapman MH, Thorburn D, Hirschfield GM et al. British Society of Gastroenterology and UK PSC guidelines for the diagnosis and management of primary sclerosing cholangitis. Gut. 2019 Aug;68 8 1356 1378. Open https://web.pathway.md/diseases/reckikcucSpfA7am4 11/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway 2. Jean-Marc Dumonceau, Christine Kapral, Lars Aabakken et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy ESGE Guideline. Endoscopy. 2020 Feb;52 2 127 149. Open 3. ASGE Standards of Practice Committee, Vinay Chandrasekhara, Mouen A Khashab et al. Adverse events associated with ERCP. Gastrointest Endosc. 2017 Jan;85 1 32 47. Open 4. Christopher L Bowlus, Lionel Arriv , Annika Bergquist et al. AASLD Practice Guidance on Primary Sclerosing Cholangitis and Cholangiocarcinoma. Hepatology. 2022 Sep 9. Open 5. ASGE Standards of Practice Committee, Krishnavel V Chathadi, Vinay Chandrasekhara et al. The role of ERCP in benign diseases of the biliary tract. Gastrointest Endosc. 2015 Apr;81 4 795 803. Open 6. Lindor KD, Kowdley KV, Harrison ME. ACG Clinical Guideline: Primary Sclerosing Cholangitis. 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Can J Surg. 2016 Apr;59 2 128 40. Open 17. Maisam Abu-El-Haija, Soma Kumar, Jose Antonio Quiros et al. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr. 2018 Jan;66 1 159 176. Open 18. Michele Pisano, Niccol Allievi, Kurinchi Gurusamy et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020; 15 61. Open https://web.pathway.md/diseases/reckikcucSpfA7am4 12/13 6/29/23, 4:17 AM Endoscopic retrograde cholangiopancreatography Pathway 19. ASGE Standards of Practice Committee, Buxbaum JL, Abbas Fehmi SM et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc. 2019 Jun;89 6 1075 1105.e15. Open 20. ASGE Standards of Practice Committee, V Raman Muthusamy, Vinay Chandrasekhara et al. The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. Gastrointest Endosc. 2016 Jul;84 1 1 9. Open 21. Crockett SD, Wani S, Gardner TB et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology. 2018 Mar;154 4 1096 1101. Open 22. Federico Coccolini, Leslie Kobayashi, Yoram Kluger et al. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES AAST guidelines. World J Emerg Surg. 2019 Dec 11;14 56. Open 23. EASL. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016 Jul;65 1 146 181. Open 24. Lepp niemi A, Tolonen M, Tarasconi A et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019 Jun 13;14 27. Open 25. Jean-Marc Dumonceau, Andrea Tringali, Ioannis S Papanikolaou et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy ESGE Clinical Guideline Updated October 2017. Endoscopy. 2018 Sep;50 9 910 930. Open https://web.pathway.md/diseases/reckikcucSpfA7am4 13/13