Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) in the evaluation of suspected pancreatic carcinoma: diagnostic limitations and contemporary roles.

The accuracy of ERCP and PTC in the diagnosis of pancreatic carcinoma was evaluated in a series of 376 and 112 patients, respectively. ERCP had a sensitivity of 94% and a specificity of 97%; PTC had a sensitivity of 100% and a specificity of 96%. Prior to the introduction of CT, these highly accurate examinations were the first major diagnostic procedures performed in patients with suspected pancreatic carcinoma. CT has had a significant impact on the role of ERCP and PTC and has replaced them as the initial procedure of choice. The current indications for ERCP and PTC were evaluated in a series of 211 patients with suspected pancreatic disease who were studied initially by CT. ERCP is now used to evaluate patients in whom CT is normal, equivocal, or technically unsatisfactory. PTC is used as a preoperative procedure for precise definition of biliary anatomy or for percutaneous placement of a palliative biliary drainage catheter.