Endoscopic retrograde cholangiopancreatography (en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee) (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion.
The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.
ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x rays.
For the procedure, you will lie on your left side on an examining table in an x-ray room. You will be given medication to help numb the back of your throat and a sedative to help you relax during the exam. You will swallow the endoscope, and the physician will then guide the scope through your esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum.
At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x rays. X rays are taken as soon as the dye is injected ERCP takes 30 minutes to 2 hours.
You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.
Procedure
During ERCP, a gastroenterologist (doctor who specializes in treating diseases of the gastrointestinal system), uses a special endoscope (a long, flexible tube with a light and camera at the end) to examine the inside of the digestive system. The doctor identifies the place where the bile duct comes into the intestine and then feeds a tiny catheter (a plastic tube) into the duct and squirts in a contrast agent while X-rays are taken. The contrast agent allows the doctors to see the bile ducts, the gallbladder, and the pancreatic duct on the X-rays.
Once the source of the problem is identified, the doctor may then treat it by performing one of the following procedures.
Sphincterotomy. This involves making a small incision in the opening of the pancreatic duct or the bile duct, which can help small gallstones, bile, and pancreatic juice to drain appropriately.
Stent placement. A stent is a plastic drainage tube that is placed in the bile duct or the pancreatic duct and allows it to drain.
Gallstone(s) removal. ERCP can remove gallstones from the bile duct, not the gallbladder itself.
Q. What are the risks of having an ERCP ?
A sore throat after the examination is common and should resolve after a few hours.
There is a small risk of damage to crowned teeth or dental bridgework
A reaction to the drugs used during the test may require you to stay in hospital.
ERCP can cause acute pancreatitis (inflammation of the pancreas) in 1 in 50 patients. Antibiotics may be given to help prevent this but it may result in a prolonged stay in hospital and occasionally a surgical operation is necessary to treat it.
ERCP may result in infection within the bile duct. This is usually treatable with antibiotics that may be given prior to the procedure, but occasionally it may be serious.
ERCP may result in bleeding particularly if the bile duct needs to be cut. The bleeding can usually be stopped by an injection through the endoscope, but if it is serious a surgical operation may become necessary. If required, a blood sample will be taken before your test to check your clotting levels.
Risk factors during the procedure
Bleeding disorder
Young age
Female sex
History of ERCP-related pancreatitis
Sphincter of Oddi dysfunction
Pregnancy
Recent or chronic illness
Heart or lung problems
The list of of Gastroenterology Hospitals in India is as follows : -
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