Charles J. Lightdale, MD, Consulting Editor

In the mid-1970s, therapeutic ERCP burst upon the endoscopic scene, most notably endoscopic sphincterotomy, with associated devices for removing ductal stones and placing stents for palliation of malignancy. As imaging with ultrasound, computed tomography, and MRI, MRCP improved; diagnostic ERCP has decreased except for the most difficult diagnostic problems, while therapeutic ERCP has continued to grow. It is estimated that currently more than 500,000 ERCP procedures are performed annually in the United States.

The great benefits of therapeutic ERCP have been clearly shown in many biliary and pancreatic diseases, where they have greater success than radiologic interventions, and success equal to many open and laparoscopic surgical procedures with considerably less morbidity. The most recent challenge to ERCP, however, has been the demonstrated transmission of multidrug-resistant organisms via the duodenoscopes used for ERCP despite stringent cleaning and disinfection. The culprit appears to be the complex elevator system used to guide instruments during ERCP. All the GI societies in the United States have cooperated with instrument manufacturers, hospitals, and the US Food and Drug Administration (FDA) to recommend carrying out even more aggressive cleaning, disinfection, and sterilization of duodenoscopes coupled with continuous testing and monitoring for bacterial contamination. One thing is clear: these incidents are very infrequent. In the words of the FDA leadership: “Fortunately, the vast majority of ERCPs are conducted without incident and often to the patient’s great benefit. For most patients, the benefits of this potentially life-saving procedure far outweigh the risks of possible infection.” Patients likely to benefit from ERCP should have these issues thoroughly discussed during the informed consent process.

It is most opportune that we have an issue of the Gastrointestinal Endoscopy Clinics of North America dedicated to “Advances in Endoscopic Retrograde Cholangiopancreatography.” The Guest Editor is Adam Slivka, MD, PhD, widely known as a thought-leader in the field, and one who insists on data to guide endoscopic practice. He has chosen topics that brightly illustrate the wide advances made by ERCP in recent years and has corralled a dream-team of skilled specialists as authors. The huge benefits of modern ERCP are evident in every article. This issue should have wide appeal to gastroenterologists at all levels, as well as surgeons, radiologists, and all those interested in liver and pancreatic diseases.