ERCP
Endoscopic Retrograde CholangioPancreatography
Endoscopic retrograde cholangiopancreatography ( ERCP) is a procedure where a flexible, lighted tube is inserted through the mouth, allowing doctors to see the duodenum, pancreatic ducts & biliary tree. The instruments help doctors diagnose and treat severe, often life-threatening, diseases such as cancer or gallstones in the pancreas and bile ducts. The advantage of this procedure is that it is less invasive than traditional surgery.
What does an ERCP involve?
The procedure is performed in three main steps:
⦁ You will be lying down on your left side, on the fluoroscope ( special X-Ray) bed;
⦁ You will be given intravenous sedation;
⦁ An endoscope with a camera on one of its ends will be passed through your mouth to the oesophagus then into your duodenum. The doctor will be able to see the images projected by the camera on a screen. The endoscope will also inject a contrast medium which will allow for a fluoroscopy / imaging to be carried out as well.
What is ERCP used for? Diagnostic
You may need an ERCP if:
⦁ Gall stones are present either in the gall bladder, pancreatic ducts, or biliary tree
⦁ You have obstructive jaundice – yellowing of the eyes and skin
⦁ You have pancreatitis, which can be either acute or chronic
⦁ Benign or malignant pancreatic cancer
⦁ You’re suffering from pancreas divisum, that is, an anomaly of the pancreas where the pancreatic duct is divided into two ducts instead of being a single duct
⦁ You need to take a pancreatic tissue sample or bile duct cells sample for a biopsy. This is also extremely helpful when it comes to confirming a diagnosis of pancreatic cancer or cancer of the bile ducts.
What is ERCP used for? Therapeutic
⦁ Eliminating bile duct stones / gall stones
⦁ Doing a biliary stent, that is, putting a tube inside the bile duct to treat an obstruction or narrowing
⦁ Treating a bile duct stricture / narrowing
What are the Risks of ERCP?
Potential complications include:
- Inflammation of the pancreas ( pancreatitis) or gallbladder ( cholecystitis) and other associated organs.
- Organ perforation ( gastrointestinal/ hepatobiliary tract). Treatment Failure – Findings during treatment may result in additional treatment if necessary.
- Others include, but are not limited to, infection, bleeding, bile pooling Accumulation of bile outside the biliary system (Biloma)
ERCP may not be possible if?
- Gastrointestinal (GI) surgery to block a bile duct was done.
- Have sacs in the esophagus ( esophageal diverticula) or other anatomic changes that make examination difficult. ERCP may be modified to work in these situations.
- Barium buildup in the bowel from recent barium therapy as this may interfere with ERCP.
- Other risks may exist depending on the situation. Be sure to discuss any concerns with your doctor before undergoing the procedure.
How should I prepare for an ERCP?
Here are some recommendations for preparing for an ERCP:
- Before booking your procedure, make sure you have disclosed possible pregnancy, any sensitivity or allergic reaction to any contrast dye, iodine, medicines, latex, tape, or anesthesia.
- Do not eat or drink for 8 hours prior to procedure. You will receive detailed special dietary instructions 1-2 days before your procedure.
- Tell your doctor about all medications ( prescription and over-the-counter) and herbal supplements you take.
- Tell your doctor if you have a history of bleeding disorders or if you are taking blood thinners ( anticoagulants), aspirin, ibuprofen, naproxen, or any other medicine that affects blood clotting. You may be asked to stop taking these drugs before surgery.
- If you have heart valve disease, your doctor may give you antibiotics before surgery.
What happens during an ERCP?
ERCP can be done on an outpatient basis or during hospitalization. Procedures may vary depending on your condition and the practices of your healthcare provider. In general, ERCP follows this process:
1. You must remove all clothing, jewelry, and other items that will interfere with the procedure.
2. You must take off your clothes and put on a hospital gown.
3. An intravenous (IV) line is placed in your arm or hand.
4. Oxygen may be supplemented through a nasal tube during the procedure.
5. You will be told to sleep on your left side on the x-ray table, or more commonly on the abdomen.
6. Xylocaine numbing spray is sprayed at the back of your throat, to prevent discomfort and gagging when the endoscope passes down the throat. The saliva that is collected in your mouth will be suctioned out with the help of a suction catheter.
7. A mouth guard will be placed in your mouth to prevent chewing on the endoscope and also to protect your teeth.
8. After the sedatives and the throat numbing medication are given and you have relaxed, the doctor will guide an endoscope in your mouth down to the esophagus, into the stomach, through the duodenum, and into the ducts of the biliary tree.
9. A thin tube is passed through the endoscope to the biliary tree and a contrast medium is injected into the tube. Air can be injected before the contrast agent. This can make you feel bloated in your abdomen.
10. X-rays will be taken during the procedure; hence you will be requested to change positions.
11. Contrast dye will be injected into the pancreatic duct, after X-rays of the biliary tree are taken and the small tube for dye injection is repositioned to the pancreatic duct. Again, you may be asked to change positions while the X-rays are taken.
12. Samples of fluid or tissue from the organ may be taken if need be. The healthcare provider may also carry out other procedures like gallstones removal or other blockages while the endoscope is in place.
13. After the procedure is complete and X-ray images taken, the endoscope will be removed.
What happens after ERCP?
You will be transported to the recovery room after the treatment. You will be transferred to your hospital room or discharged home as soon as your breathing, pulse, and blood pressure are under control and you are fully awake. Arrange for a relative to drive you home if the procedure was performed as an outpatient procedure. Until your gag reflex does not return, you will not be permitted to eat or drink anything. For a few days, you may experience a soreness in your throat and have swallowing discomfort. Do not worry, this is normal. To lower the risk of pancreatitis, a specific medication is frequently administered as a rectal suppository after the ERCP.
Normal diet and activities can be resumed after the procedure unless your healthcare provider advises otherwise.
Inform your healthcare provider if you have any of the following symptoms:
- Fever or chills
- Redness, swelling, or bleeding or other drainage from the IV site
- Abdominal pain, nausea, or vomiting
- Black, tarry, or bloody stools
- Trouble swallowing
- Throat or chest pain that worsens
Other instructions may be given by your healthcare provider after the procedure, based on your situation.
