Therapeutic pancreaticobiliary endoscopy.

The remarkable advances achieved in the performance of therapeutic endoscopic retrograde cholangiopancreatography have placed endoscopy in the forefront in the schema for treating pancreaticobiliary disorders. Since the introduction of sphincterotomy and its impact on the management of stone disease, we have seen rapid development of alternative methods for treating obstructive jaundice, neoplasia of the biliary tree, and benign disorders. In addition, endoscopists are treating strictures and fistulas of the bile duct and pancreas, gallbladder disease, and more spectacularly, gallstone pancreatitis. Endoscopic therapy compares favorably with surgery in managing cholangitis, and it is the treatment of choice for many disorders affecting the biliary tree and the pancreas. Because of the safety, efficacy, and cost-effectiveness of endoscopy, the demand for increasing the spectrum of disorders continues. We discuss techniques and results of endoscopic treatment of a broad range of diseases.