ERCP
ERCP
stands for endoscopic retrograde cholangiopancreatography. As hard as this is to
say, the actual exam is fairly simple. A dye is injected into the bile and
pancreatic ducts using a flexible, video endoscope. Then x-rays are 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 flexible endoscope is a remarkable piece of equipment that can be directed
and moved around the many bends in the upper gastrointestinal tract. The newer
video endoscopes have a tiny, optically sensitive computer chip at the end.
Electronic signals are then transmitted up the scope to the computer which then
displays the image on a large video screen. An open channel in the scope allows
other instruments to be passed through it to perform biopsies, inject solutions,
or place stents.
Reasons for the Exam
Due to factors related to diet, environment and heredity, the bile ducts,
gallbladder and pancreas are the seat of numerous disorders. These can develop
into a variety of diseases and/or symptoms. ERCP helps in diagnosing and often
in treating the condition.
ERCP is used for:
Preparation
The only preparation needed before an ERCP is to not eat or drink for eight
hours prior to the procedure. You may be asked to stop certain medications such
as aspirin before the procedure. Check with the physician.
The
Procedure
An ERCP uses x-ray films and is performed in an x-ray room. The throat is
anesthetized with a spray or solution, and the patient is usually mildly
sedated. The endoscope is then gently inserted into the upper esophagus. The
patient breathes easily throughout the exam, with gagging rarely occurring. A
thin tube is inserted through the endoscope to the main bile duct entering the
duodenum. Dye is then injected into this bile duct and/or the pancreatic duct
and x-ray films are taken. The patient lies on his or her left side and then
turns onto the stomach to allow complete visualization of the ducts. If a
gallstone is found, steps may be taken to remove it. If the duct has become
narrowed, an incision can be made using electrocautery (electrical heat) to
relieve the blockage. Additionally, it is possible to widen narrowed ducts and
to place small tubing, called stents, in these areas to keep them open. The exam
takes from 20 to 40 minutes, after which the patient is taken to the recovery
area.
Results
After the exam, the physician explains the results. If the effects of the
sedatives are prolonged, the physician may suggest an appointment for a later
date when the patient can fully understand the results.
Benefits
An ERCP is performed primarily to identify and/or correct a problem in the bile
ducts or pancreas. This means the test enables a diagnosis to be made upon which
specific treatment can be given. If a gallstone is found during the exam, it can
often be removed, eliminating the need for major surgery. If a blockage in the
bile duct causes yellow jaundice or pain, it can be relieved.
Alternative Testing
Alternative tests to ERCP include certain types of x-rays (CAT scan, CT) and
sonography (ultrasound) to visualize the pancreas and bile ducts. In addition,
dye can be injected into the bile ducts by placing a needle through the skin and
into the liver. Small tubing can then be threaded into the bile ducts. Study of
the blood also can provide some indirect information about the ducts and
pancreas.
Side Effects and Risks
A temporary, mild sore throat sometimes occurs after the exam. Serious risks
with ERCP, however, are uncommon. One such risk is excessive bleeding,
especially when electrocautery is used to open a blocked duct. In rare
instances, a perforation or tear in the intestinal wall can occur. Inflammation
of the pancreas also can develop. These complications may require
hospitalization and, rarely, surgery.
Due to the mild sedation, the patient should not drive or operate machinery
for six hours following the exam. For this reason, a driver should accompany the
patient to the exam.
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