ERCP
ERCP stands for Endoscopic Retrograde Cholangio-Pancreatography. As hard as
it is to say, the actual examination is fairly simply. A dye is injected into
the bile and pancreatic ducts using a flexible, video endoscope. X-rays are then
taken to outline the bile ducts and pancreas.
The liver produces bile, which flows through the ducts, passes or fills the
gallbladder and then enters the intestine (duodenum) just beyond the stomach.
The pancreas, which is six to eight inches long, sits behind the stomach. This
organ secretes digestive enzymes that flow into the intestine through the same
opening as the bile. Both bile and enzymes are needed to digest food.
Equipment
The video endoscope is a remarkable piece of equipment that can be directed
and moved around the many bends in the upper gastrointestinal tract. A thin,
glass fiberoptic bundle collects light at one tip of the scope and, regardless
of how it is angled, transmits the image to the other viewing end. An open
channel in the scope allows other instruments to be passed through it to perform
biopsies, remove polyps or inject solution.
Reasons for examination
Due to factors related to diet, environment and heredity, the bile ducts,
gallbladder and pancreas are the cause of numerous disorders. These can develop
into a variety of diseases and/or symptoms.
ERCP helps in diagnosing and often in treating these
conditions:
Gallstones, which are trapped in the main bile ducts
Blockage of the bile duct
Jaundice, which turns the skin yellow and the urine dark (due to an
obstruction)
Undiagnosed upper-abdominal pain
Cancer of the bile ducts or pancreas
Pancreatitis (inflammation of the pancreas)
Preparation
The only preparation needed before an ERCP is not to eat or drink for eight
(8) hours prior to the procedure.
As you will be given sedatives/anaesthetics during the procedure, you must
arrange for a relative or friend to escort you home and stay with you overnight.
Prior to your ERCP
Your doctor will discuss why an ERCP is being performed, potential
complications from ERCP and alternative diagnostic or therapeutic tests that are
available.
What can be expected during ERCP?
A local anaesthetic will be sprayed to you r throat and an intravenous
anaesthetic/sedative will be given to make you more comfortable during the test.
Most patients also receive antibiotics before the procedure.
The test begins with you lying on your left side on an X-ray table. The
endoscope is passed through the mouth, oesophagus and stomach into the duodenum.
The instrument does not interfere with your breathing. Some air is introduced
and may cause temporary bloating during and after the procedure. The injection
of contrast into the ducts rarely causes discomfort.
What are the possible complications of ERCP?
ERCP is generally a well-tolerated procedure when performed by specialists
who have had training and experience in this technique.
Major complications requiring hospitalisation can occur but are uncommon
during diagnostic ERCP. They include serious pancreatitis, infections, bowel
perforation and bleeding with each occurring in less than 1% of patients.
Another potential risk of ERCP is an adverse reaction to the anaesthetic/sedative
used. The risks of the 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
specialist will tell you what your likelihood of complications is before
undergoing the test.
If therapeutic ERCP is performed (cutting an opening in the bile duct
Sphincterotomy stone removal, dilation of a stricture, stent or drain
placement, etc) the possibility of a complication is somewhat higher.
Pancreatitis in 3-5%
Bleeding requiring transfusion in 2-3%
Bowel perforation in 1-2%
These risks must be balanced against the 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
surgery.
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