Endoscopic Management of Biliary Disorders: Diagnosis and Therapy.

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic and therapeutic tool to a predominantly therapeutic tool. There is a limited role for diagnostic ERCP with widespread availability of magnetic resonance cholangiopancreatography and endoscopic ultrasound (EUS). Since its introduction, EUS evolved from a diagnostic imaging modality to one with combined diagnostic and therapeutic capabilities. Currently, ERCP remains the standard of care for biliary decompression. In future, it is possible that EUS guided transmural biliary drainage may replace ERCP for certain indications. Given the risk of adverse events related with these more invasive endoscopic procedures, a multidisciplinary team-based approach is recommended.