Overview of endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography, or ERCP, is a procedure that detects and treats problems such as the liver, gallbladder, bile ducts, and pancreas. It combines the use of X-rays and a long, flexible, lighted endoscope tube. Your healthcare provider guides the range through your mouth and throat, then down the first part of the esophagus, stomach, and small intestine (duodenum).
Your healthcare provider can examine the inside of these organs and check for problems. Then he or she passes a tube through the scope and injects the dye. Highlight the organs on the x-ray.
Why ERCP is done?
Doctors perform ERCP to diagnose and treat problems in the pancreatic duct and bile duct. For example, if your doctor suspects pancreas or liver disease or a problem with the bile ducts, you may have an endoscopic retrograde cholangiopancreatography.
You may also have endoscopic retrograde cholangiopancreatography to find the cause of abnormal results from a blood test, ultrasound, or CT scan, or to diagnose a problem identified in one of these tests. Finally, endoscopic retrograde cholangiopancreatography can help your doctor determine if you need surgery and, if so, which one is best.
Causes of ERCP
The most common causes of ERCP are:
- Yellow skin or eyes (jaundice), light stools, and dark urine
- Stones in the bile or pancreatic duct
- Ulcer or tumor of the pancreas, gallbladder, or liver.
Your doctor may perform ERCP before or after gallbladder surgery in certain circumstances. For example, they can find and remove gallstones from the bile duct and sometimes the pancreas. Endoscopic retrograde cholangiopancreatography can also help detect cancer or non-cancerous lesions.
If your bile duct is blocked, your doctor may use endoscopic retrograde cholangiopancreatography to place it in a small plastic tube called a “stent.” It opens the duct and drains the digestive juices. Finally, endoscopic retrograde cholangiopancreatography can help diagnose and treat complications after gallbladder surgery.
Preparation for ERCP
Follow your doctor’s instructions for steps to take before the procedure. In general, you should:
- Do not eat, drink, or smoke for at least six hours before the procedure. Clear liquids like water can be fine.
- Warn your doctor about any allergies, especially allergic reactions before the intravenous (IV) contrast dial. If you have a previous reaction, you may need to take allergy medicine before the procedure.
- Give your doctor’s office a current list of medications and drugs.
- Talk to your doctor about whether you should stop taking blood thinners such as aspirin and warfarin.
- Tell your doctor if you are pregnant. Some anesthesia can harm the fetus.
During the ERCP
During ERCP, a gastroenterologist (a doctor who specializes in treating diseases of the gastrointestinal tract) uses a special endoscope (a long, flexible tube with a light and a camera on the end) to examine the inside of the gastrointestinal tract. The doctor identifies the area where the bile duct enters the intestine and then inserts a small catheter (a plastic tube) into the duct and surrounds the contrast agent while taking the X-rays. The contrast agent allows doctors to see the bile ducts, gallbladder, and pancreatic duct on X-rays.
Once the source of the problem is identified, the doctor can treat it using one of the following procedures:
Sphincterotomy: This involves making a small incision (cut) at the beginning of the pancreatic duct or bile duct, which helps to properly drain small gallstones, bile, and pancreatic juices.
Stent placement: A stent is a drainage tube that is placed in the bile duct or pancreatic duct, allowing the duct to remain open and drain.
Removal of the gallbladder: Endoscopic retrograde cholangiopancreatography can help to remove gallstones from the bile duct, but not from the gallbladder.
After the ERCP
The endoscopic procedure can irritate your throat. You will need to eat soft foods for a day or two days until the sores disappear.
After ERCP, you may experience some bloating (swelling from the pumping air) and nausea (a side effect of anesthesia). With your doctor’s permission, you can return to work and your normal activities the next day.
How had ERCP done?
During ERCP, the doctor uses a special narrow, flexible tube (endoscope) that holds the video camera. When the baby is asleep, the tube is placed into the upper digestive tract through the baby’s mouth. Contrast dye with X-rays allows the doctor to see stones, abnormal constriction, or obstruction in the vessels. To treat these problems, the doctor slides small surgical instruments through the scope to treat the problems he finds.
Sometimes this process is only used to diagnose the problem. Most ERCP procedures involve treatment. Treatment includes:
- Sphincterotomy: An incision that increases the initial size of the pancreatic duct
- Stenting: Inserting a small temporary plastic tube into the duct to prevent drainage.
- Stone extraction: Used to clean stone vessels
- Stenosis dilation: Used to dilate or dilate an area where the duct is abnormally narrow or narrow
- ERCP can last between 20 minutes and two hours, depending on the type of treatment required.
Is ERCP safe?
ERCP is considered a low-risk process. However, problems can arise. These include pancreatitis, infections, intestinal perforation, and bleeding. Patients who undergo ERCP for treatment, such as gallbladder removal, have a higher risk of complications than patients who undergo tests to diagnose the problem. Your doctor will discuss any problems that may arise prior to the test.
Side effects of ERCP
ERCP is a very specialized approach that requires a lot of experience and skill. This procedure is very safe and is associated with very little risk when performed by experienced physicians. The success rate in performing this procedure ranges from 70% to 95% depending on the experience of the physician. About one to five percent of problems occur depending on the skill of the doctor and the underlying disorder.
Pancreatitis is a very common problem caused by irritation of the pancreas from the color used for taking pictures and it also occurs with most experienced doctors. This “shot” of pancreatitis is usually treated in the hospital for a day or two. Infection is another problem. Other serious accidents include bowel perforation, drug reactions, bleeding, and depressed breathing. Irregular heartbeats or heart attacks are very rare and are mainly due to poisoning. In the event of complications, patients generally must be admitted to the hospital, but surgery is rarely necessary.
In summary, ERCP is a simple but specialized patient test performed on an anesthetized patient under intravenous or general anesthesia. This process provides important information that constitutes a specific treatment. In some cases, treatment can be performed simultaneously with a duodenoscope, thus avoiding traditional open surgery. ERCP, in combination with endoscopic ultrasound, is currently the preferred diagnostic and therapeutic approach for the detection and removal of gallstones in most patients.
Risk factors of ERCP
Some people have an allergic reaction to the intravenous dye used during the x-ray of the procedure. If this happens, your doctor will quickly prescribe medicine to stop the reaction. Other rare but potential problems:
- Infection of the gallbladder or bile duct
- Hole (perforation) in the stomach, vessels, or small intestine
- Inflamed and inflamed pancreas (pancreatitis)
- Internal bleeding