ERCP

1 What is an Endoscopic Retrograde Cholangio-Pancreatography (ERCP)?

Endoscopic retrograde cholangio-pancreatography (ERCP) is a diagnostic procedure to examine pancreas, liver, bile duct, gallbladder and the papilla of Vater because they can be involved in numerous diseases, causing a myriad of symptoms.

It is used in diagnosing and treating:

  • Blockage of the bile duct by stones
  • Cancer
  • Structure or compression from adjacent organs
  • Persistent or recurrent upper abdominal pain which cannot be diagnosed by other tests
  • Unexplained loss of appetite and weight loss
  • Confirming the diagnosis of cancer of the pancreas or the bile duct, so that surgery or other treatment can be tailored, etc.

Before the procedure, the patient must not eat anything after midnight on the day of the procedure. If the procedure is performed early in the morning, no liquid should be taken but if it is performed at noon time, a cup of tea, juice, milk, or coffee can be taken 4 hours earlier.

During the procedure, the patient will be given medication through a vein to cause relaxation and sleepiness and some local anesthetic or intravenous medication for sedation to decrease the gag reflex.

The patient is lying on the left side on the x-ray table and then a duodenoscopy (a long, flexible, viewing instrument about the diameter of a pen) is inserted gently through the mouth to the back of the throat, down the food pipe, through the stomach and into the first portion of the small intestine (duodenum).

Once the papilla of Vater is identified, a small plastic catheter (cannula) is passed through an open channel of the duodenoscopy into the papilla of Vater, and into the bile ducts and/or the pancreatic duct. Contrast material (dye) is then injected and x-rays are taken of the bile ducts and the pancreatic duct.

The open channel also allows other instruments to be passed through it in order to perform biopsies, to insert plastic or metal tubing to relieve obstruction of bile ducts caused by cancer or scarring, and to perform incision by using electrocautery (electric heat).

The procedure can last anywhere from fifteen minutes to one hour, depending on the skill of the physician and the anatomy or abnormalities in that area.

After the procedure, the patients will stay in the recovery area until most of the effects from the medication have worn off (usually takes one to two hours). Then the physician may explain to the patient or companion regarding the findings after the procedure.

The other person must drive the patient home because of the used of sedation. The patient can resume usual activity the next day.

The procedure is quite safe and is associated with a very low risk when it is performed by experienced physicians. Complications are very rare but they can include: pancreatitis which is due to irritation of the pancreas and can occur even in very experienced physicians but it can be usually treated in the hospital for one to two days, and infection.

Other serious risks including perforation of the bowel, drug reactions, bleeding, depressed breathing, irregular heartbeat or heart attack are extremely rare.

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