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ERCP may be useful in diagnosing and treating problems causing jaundice (a yellowing of the whites of the eyes and skin) or pain in the abdomen. Also, there may be changes in blood tests that show abnormalities of the liver or pancreas. ERCP is an effective and useful procedure for evaluation or treating a number of different problems of the GI tract.
ERCP is short for “Endoscopic Retrograde Cholangio Pancreatography”.
Refers to the use of an instrument called an endoscope – a thin, flexible tube with a tine video camera and light on the end. The endoscope is used by a highly trained subspecialist, the gastroenterologist, to diagnose and treat various problems of the GI tract. The GI tract includes the stomach intestine, and other parts of the body that are connected to the intestine, such as the liver, pancreas and gallbladder.
Refers to the direction in which the endoscope is used to inject a liquid enabling X-rays to be taken of the parts of the GI tract called the bile duct system and pancreas.
The process of taking these X-rays is known as cholangiopancreatography.
Refers to the bile duct system, pancreas to the pancreas.
ERCP may be useful in diagnosing and treating problems causing jaundice (a yellowing of the whites of the eyes and skin) or pain in the abdomen. Also, there may be changes in blood tests that show abnormalities of the liver or pancreas.
To understand how ERCP can help, it’s important to know more about the pancreas and the bile duct system.
Bile is a substance made by the liver that is important in the digestion and absorption of fats. Bile is carried from the liver by a system of tubes known as bile ducts. One of these, the cystic duct, connects the gallbladder to the main bile duct. The gallbladder stores the bile between meals and empties back into the bile duct when food is consumed. The common bile duct then empties into a part of the small intestine called the duodenum. The common bile duct enters the duodenum through a nipple-like structure called the papilla. Joining the common bile duct to pass through the papilla is the main duct from the pancreas. This pathway allows digestive juices from the pancreas to mix with food in the intestine. Problems that affect the pancreas and bile duct system can, in many cases, be diagnosed and corrected with ERCP.
For example, ERCP can be helpful when there is a blockage of the bile ducts by gallstones, tumors, scarring or other conditions that cause obstruction or narrowing (stricture) of the ducts. Similarly, blockage of the pancreatic ducts from stones, tumors or stricture can also be evaluated or treated by ERCP, which is useful in assessing causes of pancreatitis (inflammation of the pancreas).
Other special exams that take pictures using X-rays or sound waves provide important information for use along with that obtained from ERCP.
Prior to having ERCP, there are a number of things you will need to remember:
ERCP requires hospitalization. Your doctor will explain the procedure and its benefits and risks, and you will be asked to sign an informed consent form. This form verifies that you agree to have the procedure and understand what’s in involved.
What to expect
Everything will be done to ensure your comfort. Your blood pressure, pulse, and the oxygen level in your blood will be carefully monitored. A sedative will be given through a vein in your arm. You will feel drowsy, but will remain awake and able to cooperate during the procedure.
An anaesthetist is present during the procedure for a better and safer experience.
An endoscope is passed into your oesophagus via your mouth. The doctor will use it to inspect the lining of your stomach and duodenum. You should not feel any pain, but you may have a sense of fullness, since air may be introduced to help advance the scope.
In the duodenum, the instrument is positioned near the papilla, the point at which the main ducts empty into the intestine. A small tube known as a cannula is threaded down through the endoscope and can be directed into either the pancreatic or common bile duct. The cannula allows a special liquid contrast material, a dye, to be injected backwards – that is, retrograde – through the ducts.
X-ray equipment is then used to examine and take pictures of the dye outlining the ducts. In this way, widening, narrowing, or blockage of the ducts can be pinpointed.
Some of the problems that may be identified during ERCP can also be treated through the endoscope. For example, if a stone is blocking the pancreatic or common bile duct, it is usually possible to remove it.
First, the opening in the papilla is cut open and enlarged. Then, a special device can be inserted to retrieve the stone. Narrowing or obstruction can also have other causes, such as scarring or tumors. In some cases, a plastic or metal tube (called a stent), can be inserted to provide an opening. If necessary, a tissue sample or biopsy can be obtained, or a narrow area dilated.
Thanks to ERCP, these kinds of procedures may help you avoid surgery.
Depending on the individual and the types of procedures performed, ERCP does have a five to ten percent risk of complications. In rare cases, severe complications may require prolonged hospitalization.
Mild to severe inflammation of the pancreas is the most common complication and may require hospital care, even surgery. Bleeding can occur when the papilla has to be opened to remove stones or put in stents. This bleeding usually stops on its own, but occasionally, transfusion may be required or the bleeding may be directly controlled with endoscopic therapy.
A puncture of perforation of the bowl wall or bile duct is a rare problem that can occur with therapeutic ERCP.
Infection can also result, especially if the bile duct is blocked and bile cannot drain. Treatment for infection requires antibiotics and restoring drainage. Finally, reactions may occur to any of the medications used during ERCP, but fortunately these are usually minor.
Be sure to discuss any specific concerns you may have about the procedure with your doctor.
You will need to remain under observation until your doctor or healthcare team has decided you can return home.
When you do go home, be sure you have arranged for someone to drive you, since you’re likely to be sleepy from the sedative your received. This means, too, that you should avoid operating machinery for a day, and not drink any alcohol.
Your doctor will tell you when you can take fluids and meals. Usually, it is within a few hours after procedure.
Because of the air used during ERCP, you may continue to feel full and pass gas for a while, and it is not unusual to have soft stool or other brief changes in bowel habits. However, if you notice bleeding, from your rectum or black, tarry stools, call your doctor.
You should also report vomiting, severe abdominal pain, weakness or dizziness, and fever over 100 degrees. Fortunately, these problems are not common.
This practice is dedicated to providing care of the highest ethical and medical standards. Our approach is one of careful and thorough assessment with the aim of problem-solving. We also aim to empower our clients with knowledge to better understand and manage their condition.