Endoscopic retrograde cholangiopancreatography (ERCP)

Published on 06 Sep 2021

Introduction

Endoscopic retrograde cholangiopancreatography, or ERCP, is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and the use of an endoscopea long, flexible, lighted tube. Your healthcare provider guides the scope through your mouth and throat, then down the oesophagus, stomach, and the first part of the small intestine (duodenum). Your healthcare provider can view the inside of these organs and check for problems. Next, he or she will pass a tube through the scope and inject a dye. This highlights the organs on the X-ray.

The bile ducts are tubes that carry bile from your liver to your gallbladder and duodenum. The pancreatic ducts are tubes that carry pancreatic juice from the pancreas to the duodenum. Small pancreatic ducts empty into the main pancreatic duct. The common bile duct and main pancreatic duct join before emptying into your duodenum.

The need for Endoscopic retrograde cholangiopancreatography is to find the cause of unexplained abdominal pain or yellowing of the skin and eyes (jaundice). It may be used to get more information if you have pancreatitis or cancer of the liver, pancreas, or bile ducts. Doctors also use ERCP to treat problems of the bile and pancreatic ducts. For diagnosis alone, doctors may use noninvasive teststests that do not physically enter the bodyinstead of ERCP.

Doctors perform ERCP when your bile or pancreatic ducts have become narrowed or blocked because of:

Blockages or stones in the bile ducts
Fluid leakage from the bile or pancreatic ducts
Blockages or narrowing of the pancreatic ducts
Tumours
Infection in the bile ducts
Acute pancreatitis
Chronic pancreatitis
trauma or surgical complications in your bile or pancreatic ducts

How do get ready for Endoscopic Retrograde Cholangiopancreatography?

Recommendations for Endoscopic retrograde cholangiopancreatography preparation include the following:

Your healthcare provider will explain the procedure and you can ask questions.
You may be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.
Tell your healthcare provider if you have ever had a reaction to any contrast dye, or if you are allergic to iodine.
Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, or anaesthesia.
Do not eat or drink liquids for 8 hours before the procedure. You may be given other instructions about a special diet for 1 to 2 days before the procedure.
If you are pregnant or think you could be, tell your healthcare provider.
Tell your healthcare provider of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, ibuprofen, naproxen, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.
If you have heart valve disease, your healthcare provider may give you antibiotics before the procedure.
You will be awake during the procedure, but a sedative will be given before the procedure. Depending on the anaesthesia used, you may be completely asleep and not feel anything. You will need someone to drive you home.

What happens during ERCP?

Doctors who have specialized training in Endoscopic retrograde cholangiopancreatography perform this procedure at a hospital or an outpatient centre. You will need to remove any clothing, jewellery, or other objects that may interfere with the procedure. You will need to remove clothes and put on a hospital gown. An intravenous (IV) line will be put in your arm or hand. You may get oxygen through a tube in your nose during the procedure. You will be positioned on your left side or, more often, on your belly, on the X-ray table.

Numbing medicine may be sprayed into the back of your throat. This helps prevent gagging as the endoscope is passed down your throat. You will not be able to swallow the saliva that collects in your mouth during the procedure. It will be suctioned from your mouth as needed. A mouth guard will be put in your mouth to keep you from biting down on the endoscope and to protect your teeth.

Once your throat is numbed and you are relaxed from the sedative. Your provider will guide the endoscope down the oesophagus into the stomach and through the duodenum until it reaches the ducts of the biliary tree. A small tube will be passed through the endoscope to the biliary tree, and contrast dye will be injected into the ducts. Air may be injected before the contrast dye. This may cause you to feel fullness in your abdomen. Various X-ray views will be taken. You may be asked to change positions during this time. After X-rays of the biliary tree are taken, the small tube for dye injection will be repositioned to the pancreatic duct. Contrast dye will be injected into the pancreatic duct, and X-rays will be taken. Again, you may be asked to change positions while the X-rays are taken. If needed, your provider will take samples of fluid or tissue. He or she may do other procedures, such as the removal of gallstones or other blockages, while the endoscope is in place. After the X-rays and any other procedures are done, the endoscope will be withdrawn.

After ERCP, you can expect the following:

You will most often stay at the hospital or outpatient centre for 1 to 2 hours after the procedure so the sedation or anaesthesia can wear off. In some cases, you may need to stay overnight in the hospital after endoscopic retrograde cholangiopancreatography.
You may have bloating or nausea for a short time after the procedure.
You may have a sore throat for 1 to 2 days.
You can go back to a normal diet once your swallowing has returned to normal.
You should rest at home for the remainder of the day.