ERCP Procedure

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Bile ducts are the tubes that carry bile from the liver to the gallbladder and small intestine. Patient receives sedatives through an IV line. Local anaesthetic agents are also sprayed on the throat so that there is no pain while inserting the endoscopic tube. The endoscope goes through the food pipe and stomach until it reaches the duodenum (the part of the small intestine that is closest to the stomach). A thin tube (catheter) is passed through the endoscope and inserted into the tubes (ducts) that lead to the pancreas and gallbladder. A special dye is injected into these ducts, and x-rays are taken. This helps the doctor see stones, tumours, and any areas that have become narrowed. ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, such as including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.

Steps taken:

Endoscopic retrograde cholangiopancreatography (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 procedure is performed by using a long, flexible, viewing instrument (a duodenoscope) about the diameter of a pen. The duodenoscope can be directed and moved around the many bends of the stomach and duodenum. the instrument uses a thin fiber-optic bundle to transmit light to the tip of the endoscope, and a thin wire with a chip to transmit digital video images to a TV screen. The duodenoscope is inserted through the mouth, through the back of the throat, down the food pipe (oesophagus), through the stomach and into the duodenum.. Contrast material (dye) is then injected and X-rays are taken of the bile ducts and the pancreatic duct. An open channel in the endoscope also allows other instruments to be passed through it in order to perform biopsies, to insert plastic or metal tubing to relieve obstruction of the bile ducts or pancreatic duct caused by cancer or scarring, and to perform incisions by using electro-cautery (electric heat).

Advantages:

ERCP is helps to diagnose the conditions of the bile ducts and pancreatic ducts visually and can help devise the treatment options.

Precautions:

The risk of complications is higher if the patient is in poor general health. Therefore it is necessary that prior to the procedure all the physiological parameters of the patient are stable. The benefit from this procedure needs to be weighed up against the small risk of complications. It is necessary to share all the medical details with doctor to avoid complications. Doctor should know the types of past illness, current medical issues, medications, pregnancy status prior to planning the procedure.

FAQs

I am suffering from gall stones. Will ERCP help to make correct assessment?

YES; ERCP will confirm the diagnosis, size, shape and number of gall stones in your biliary system. It shall also help physician to prescribe right medication.

Do I need to be hospitalised for undergoing ERCP?

Yes; you shall need to be hospitalised for an overnight stay. The procedure is short.

Are there any complications following ERCP?

The procedure is quite safe and there are no notable complications. Sometime, one may develop allergy to the radiographic contrast media.

What are the side effects following the ERCP?

Most ERCPs are done without any problems. Some patients experience sore throat, fatigue and drowsiness due to use of sedative.

What are the rare complications of ERCP?

Rare complications include risk of developing a chest infection, following an ERCP. Some damage to the gut, bile duct or pancreatic duct leading to bleeding, infection and, rarely, perforation. Following the procedure in case of stomach pain, fever, breathlessness, vomiting with blood doctor must be immediately consulted. Inflammation of the pancreas (pancreatitis) can in few cases and could be serious.

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