ERCP (endoscopic retrograde cholangio-pancreatography)
ERCP stands for endoscopic retrograde cholangio-pancreatography. ERCP is a diagnostic test to examine the duodenum (the first portion of the small intestine), the papilla of Vater (a small nipple-like structure with openings leading to the bile ducts and the pancreatic duct), the bile ducts, the gallbladder and the pancreatic duct. The bile ducts drain bile from the liver while the pancreatic duct drains pancreatic juice from the pancreas. Both open into the first part of the small intestine (the
An endoscope is a thin, flexible, telescope. It is passed through the mouth, into the oesophagus and down towards the stomach and duodenum. The endoscope contains fibre optic channels which allows light to shine down so the doctor can see inside. Cholangio-pancreatography means x-ray pictures of the bile and pancreatic ducts. These ducts do not show up very well on ordinary x-ray pictures. But, if a contrast dye which blocks x-rays is injected into these ducts then x-ray pictures will show up these ducts clearly. Some dye is injected through the papilla back up into the bile and pancreatic ducts (a 'retrograde' injection). This is done via a plastic tube in a side channel of the endoscope. X-ray pictures are then taken.
The only preparation needed before an ERCP is to not eat or drink for eight hours prior to the procedure. You may be asked to stop certain medications such as aspirin before the procedure. Check with the physician. Heart and blood pressure medications should always be taken with a small amount of water in the early morning. Since the procedure will require intravenous sedation, the patient needs to have a companion drive him/her home after the procedure.
An ERCP is carried out in a hospital X-ray department. Because the stomach needs to be empty to allow the the endoscope to pass safely through, the patient has to fast for six hours. The throat is anesthetized with a spray or solution, and the patient is usually mildly sedated. The endoscope is then gently inserted into the upper esophagus. The patient breathes easily throughout the exam, with gagging rarely occurring. A thin tube is inserted through the endoscope to the main bile duct entering the duodenum. Dye is then injected into this bile duct and/or the pancreatic duct and x-ray films are taken. The patient lies on his or her left side and then turns onto the stomach to allow complete visualization of the ducts. If a gallstone is found, steps may be taken to remove it. If the duct has become narrowed, an incision can be made using electrocautery (electrical heat) to relieve the blockage. Additionally, it is possible to widen narrowed ducts and to place small tubing, called stents, in these areas to keep them open. The exam takes from 20 to 40 minutes, after which the patient is taken to the recovery area.
ERCP-related complications can be broken down into those related to medications used during the procedure, the diagnostic part of the procedure, and those related to endoscopic therapy. The overall complication rate is 5–10%; most of those occur when diagnostic ERCP is combined with a therapeutic procedure. During the exam, the endoscopist can cut or stretch structures (such as the muscle leading to the bile duct) to treat the cause of the patient's symptoms. Although the use of sedatives carries a risk of decreasing cardiac and respiratory function, it is very difficult to perform these procedures without these drugs.
The major complications related to diagnostic ERCP are pancreatitis (inflammation of the pancreas) and cholangitis (inflammation of the bile ducts). Bacteremia (the passage of bacteria into the blood stream) and perforation (hole in the intestinal tract) are also real risks. A temporary, mild sore throat sometimes occurs after the exam. Serious risks with ERCP, however, are uncommon. One such risk is excessive bleeding, especially when electrocautery is used to open a blocked duct. In rare instances, a perforation or tear in the intestinal wall can occur. Inflammation of the pancreas also can develop. These complications may require hospitalization and, rarely, surgery.