ERCP (Endoscopic Retrograde Cholangiopancreatography)
ERCP is a specialized technique used to study the ducts (drainage routes) of the gallbladder, pancreas and liver (the drainage channels from the liver are called bile ducts or biliary ducts). An endoscope (flexible thin tube that allows the physician to see inside the bowels) is passed through the mouth, esophagus, and stomach into the duodenum (first part of the small intestine).
After the common opening to the ducts from the liver and pancreas is visually identified, a catheter (narrow plastic tube) is passed through the endoscope into the ducts. Contrast material (“dye”) is then injected gently into the ducts (pancreatic or biliary) and x-ray films are taken. ERCP is used to diagnose and treat many diseases of the pancreas, bile duct, liver and gallbladder. Structural abnormalities suspected by symptoms, physical examination, laboratory tests or x-rays can be shown in detail and biopsies of abnormal tissues can be obtained if necessary. ERCP can make the important distinction between whether jaundice (yellow discoloration of the eyes and skin) is caused by diseases that are treated medically such as hepatitis, or structural diseases such as gallstones, tumors or strictures (obstructing scar tissue) that are treated surgically or endoscopically. In patients who are not jaundiced but have pain or laboratory abnormalities suggesting biliary or pancreatic diseases, ERCP may also provide important information. ERCP can determine whether or not surgery is necessary and is helpful in providing the anatomic detail the surgeon needs to plan an operation. The information provided by ERCP is far more detailed than that provided by standard x-rays or CT scans. Diagnostic ERCP is the first step in therapeutic ERCP. Several conditions of the biliary or pancreatic ducts can be treated (cured or improved) by ERCP techniques that can open the end of the bile duct, extract stones, and place stents (plastic drainage tubes) across obstructed ducts to improve their damage.
WHAT PREPARATION IS REQUIRED?
It is necessary to have a completely empty stomach for the best possible examination. You should therefore fast for at least 4-6 hours before the procedure. An allergy to iodine containing drugs (contrast material or ñdyeî) is not a contraindication to ERCP, but it should be discussed with your physician before the procedure. The physician performing the procedure should be informed of any medications you take regularly, any heart or lung conditions (or any other major diseases), and whether you have any drug allergies.
WHAT CAN BE EXPECTED DURING ERCP?
Your physician will discuss why ERCP is being performed, potential complications from ERCP, and alternative diagnostic or therapeutic options ts that are available. A local anesthetic may be applied to your throat and an intravenous sedative will be given to make you more comfortable during the ERCP; most patients remember or feel very little of the examination. Some patients may also receive antibiotics before the procedure. The ERCP begins with you lying face down with your head to the right on an x-ray table. The endoscope is passed through the mouth, esophagus and stomach into the duodenum. The instrument does not interfere with breathing. Air is introduced through the instrument and may cause temporary bloating during and after the procedure. The injection of contrast materials into the ducts rarely causes discomfort. The duration of the procedure varies widely from 15 minutes to 2 hours.
WHAT ARE POSSIBLE COMPLICATIONS OF ERCP?
ERCP is generally a well-tolerated procedure when performed by physicians who have special training and experience in this technique. PHLEBITIS or localized irritation of the vein into which medications were given may rarely cause a tender lump that may last several weeks. The application of heat packs or hot moist towels may ease the discomfort. Major complications requiring hospitalization can occur but are uncommon (less than 1%) during diagnostic ERCP. They include SERIOUS PANCREATITIS, INFECTIONS, BOWEL PERFORATION AND BLEEDING. Another potential risk of ERCP is an ADVERSE REACTION TO THE SEDATIVE used. The risk of procedure vary with the indications for the test, what is found during the procedure, what therapeutic intervention is undertaken, and the presence of other major medical problems, e.g. heart or lung diseases. Your physician will tell you what is your likelihood of complications before undergoing the ERCP. It must be realized that stones in the bile ducts can also lead to pain, serious pancreatitis and infection if left untreated in some patients. If therapeutic ERCP is performed (cutting an opening in the bile duct, stone removal, dilation of a stricture, stent or drain placement, etc), the possibility of complications is higher than with diagnostic ERCP. Complications again included PANCREATITIS (3-7%), BLEEDING REQUIRING A TRANSFUSION (3-5%), AND BOWEL PERFORATION (1-2%). These risks must be balanced against the potential benefits of the procedure and the risks of alternative surgical treatment of the condition. Often these complications can be managed without surgery, but occasionally they do require corrective surgery.
WHAT CAN BE EXPECTED FOLLOWING ERCP?
If you are having ERCP as an outpatient, you will be kept under observation several hours until most of the effects of the medications have worn off. Evidence of any complications of the procedure will be looked for and hospitalization may be advised if further observation or treatment is necessary. You may experience bloating or pass gas because of the air introduced during the procedure. You may resume your usual diet unless instructed otherwise.