Endoscopic retrograde cholangiopancreatography, also known as ERCP, is a diagnostic procedure performed to detect abnormalities in the liver, gallbladder, pancreas and bile ducts. ERCP combines the use of an endoscope with X-rays to obtain a detailed view of the region. Performed through an endoscope (a lighted tube snaked down the esophagus), the ERCP is used to treat obstructions of the bile ducts, including stones, tumors, or strictures (narrowed passageways).
Reasons For ERCP
ERCP is performed to detect, diagnose and treat various abnormalities of the gastrointestinal tract. Among disorders that may be investigated through this endoscopic examination are diseases of the liver or galbladder, including gallstones, cysts, tumors, cancerous and benign. ERCP may be recommended for patients who are experiencing the following symptoms:
- Loss of appetite
- Sudden, unexplained weight loss
- Darkened urine
- Severe abdominal pains
- Light-colored stools
The abdominal pain that often precipitates ERCP is usually in the middle or upper right area of the stomach.
Preparation For ERCP
It is important that the physician take a medical history before the procedure to assess any pre-existing health conditions. If the doctor considers it safe, certain medications, such as blood thinners, may be discontinued temporarily. Patients have to fast for at least 8 hours before undergoing ERCP. Prior to the procedure, diagnostic imaging tests, such as ultrasound, CT or MRI scans are administered to help the surgeon pinpoint, as closely as possible, the particular location of the trouble spot. Wherever possible ERCP is not performed on pregnant women except in emergency situations.
The ERCP Procedure
With the patient lying on the stomach or left side, intravenous sedation is administered. Once the sedative takes effect, the endoscope is inserted through the mouth into the esophagus and snaked down into the duodenom, the uppermost part of the small intestine. A catheter, or thin tube, is inserted into the endoscope and advanced into the ducts leading to the pancreas and gallbladder. A dye is injected into the ducts to enhance visualization and X-rays of the area are taken. In addition to receiving clear images of any abnormalities in the region, the surgeon is able to insert tiny instruments through the endoscope in order to perform any necessary tasks.
ERCP is not only diagnostic. Using tiny instruments inserted through the endoscope, the surgeon is able to perform minor surgeries, such as:
- Removing tissue for biopsy
- Removing abnormal growths
- Removing or crushing gallstones
- Widening the bile duct with a stent
- Draining the bile duct or other blocked areas
- Diagnosing disease conditions (biliary cirrhosis, sclerosing cholangitis)
The ERCP procedure can take as little as half an hour or as much as to 2 hours to complete, depending on whether, and how many, surgical tasks are necessary and on their complexity. Patients may expect to awaken with a dry mouth, sore throat, possible nausea and some bloating or gas. These symptoms are normal and should resolve quickly.
Risks Of ERCP
While ERCP is generally considered a safe procedure, with any medical or surgical procedures there are inherent risks. These may include:
- Adverse reactions to anesthesia, dye or medication
- Excessive bleeding
- Perforation of the bowel
In most cases, patients recover quickly from the ERCP procedure, though they should eat a light diet refrain, rest, and refrain from driving for the remainder of the day.