Endoskopik Retrograd Kolanjio Pankreotografi (ERCP)
Özet
ERCP (Endoskopik Retrograd Kolanjio Pankreotografi), pankreatiko-biliyer sistem hastalıklarının teşhis ve tedavisinde ileri endoskopik ve floroskopik görüntüleme yöntemlerini birleştiren mikroinvaziv bir prosedürdür. İlk olarak 1968 yılında ABD'de William S. McCune tarafından uygulanan bu yöntem, zaman içerisinde MRCP ve EUS gibi gelişmiş tanısal araçların yaygınlaşmasıyla birlikte modern tıpta neredeyse tamamen terapötik (tedavi edici) bir nitelik kazanmıştır. ERCP'nin en kritik ve zorlu aşaması major duodenal papillanın selektif kanülasyonudur. Prosedür; koledokolitiazis (safra yolu taşları), safra kaçakları, benign veya malign biliyer darlıklar, asendan kolanjit ve bazı pankreatik hastalıkların yönetiminde yaygın olarak tercih edilmektedir. Ancak, standart endoskopik işlemlere kıyasla %5-10 gibi yüksek bir komplikasyon riskine sahiptir. En sık karşılaşılan komplikasyonlar post-ERCP pankreatiti (PEP), kanama, enfeksiyon ve perforasyondur. Bu riskleri azaltmak amacıyla işlem öncesinde rektal indometazin profilaksisi, agresif hidrasyon ve uygun hastalarda stentleme gibi koruyucu stratejiler uygulanmaktadır. Dolayısıyla ERCP, teknik becerinin yanı sıra endikasyonların, anatomik varyasyonların ve olası komplikasyonların yönetimini de içeren kapsamlı bir uzmanlık ve multidisipliner bir ekip çalışması gerektirmektedir.
ERCP (Endoscopic Retrograde Cholangiopancreatography) is a microinvasive procedure that combines advanced endoscopic and fluoroscopic imaging to diagnose and treat diseases of the pancreaticobiliary system. First performed in 1968 by Surgeon William S. McCune in the USA, the procedure has evolved from a diagnostic tool into an almost exclusively therapeutic intervention due to the emergence of non-invasive modalities like MRCP and EUS. The cornerstone and most challenging part of ERCP is the selective cannulation of the major duodenal papilla. It is widely indicated for managing choledocholithiasis, biliary leaks, benign or malignant strictures, ascending cholangitis, and specific pancreatic disorders. Despite its efficacy, ERCP carries a substantial complication rate of 5% to 10%, making it one of the most high-risk endoscopic procedures. The most common adverse events include post-ERCP pancreatitis (PEP), hemorrhage, infection, and perforation. To minimize these risks, prophylactic strategies such as pre-procedural rectal indomethacin, aggressive hydration, and pancreatic duct stenting are routinely utilized. Consequently, performing ERCP safely requires not only advanced technical proficiency but also a comprehensive understanding of patient selection, altered anatomy, and the efficient management of post-procedural complications.
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