ERCP is short for endoscopic retrograde cholangiopancreatography. It is a procedure that looks at the bile ducts. It is done through an endoscope.
It provides detailed and accurate information of the pancreaticobiliary system in cases which cannot be diagnosed by endoscopic ultrasound. It also provides a less invasive option than open surgery for the management of several pancreatic conditions.
- Choledocholithiasis (eg, gallstones in the common bile duct (CBD) and microlithiasis).
- Acute pancreatitis due to biliary obstruction, sphincter of Oddi dysfunction or idiopathic, recurrent cases.
- Detection of pancreatic divisum (more common in patients who develop pancreatitis but may not necessarily be causal).
- Diagnosis of pancreatic and biliary malignancy. Endoscopic ultrasound provides an acceptable option in many cases and can be used as a triage procedure to determine which patients should proceed to ERCP.
- Palliative therapy for inoperable pancreaticobiliary malignancies – eg, drainage procedures.
- Dilatation of benign strictures – eg, following orthoptic liver transplantation.
- Chronic pancreatitis – very controversial but there may be a role for dilatation of strictures or stent insertion.
- Manometry measures in sphincter of Oddi dysfunction.
- Bile ducts are the tubes that carry bile from the liver to the gallbladder and small intestine.
- ERCP is used to treat stones, tumors, or narrowed areas of the bile ducts.
An intravenous (IV) line is placed in your arm. You will lie on your stomach or on your left side for the test.
Medicines to relax or sedate you will be given through the IV.
Sometimes, a spray to numb the throat is also used. A mouth guard will be placed in your mouth to protect your teeth. Dentures must be removed.
After the sedative takes effect, the endoscope is inserted through the mouth. It goes through the esophagus (food pipe) and stomach until it reaches the duodenum (the part of the small intestine that is closest to the stomach).
- You should not feel discomfort, and may have little memory of the test.
- You may gag as the tube is passed down your esophagus.
- You may feel stretching of the ducts as the scope is put in place.
- A thin tube (catheter) is passed through the endoscope and inserted into the tubes (ducts) that lead to the pancreas and gallbladder. A special dye is injected into these ducts, and x-rays are taken. This helps the doctor see stones, tumors, and any areas that have become narrowed.
Special instruments can be placed through the endoscope and into the ducts.
Why the Procedure is Performed
The procedure is used mostly to treat problems of the pancreas or bile ducts that can cause abdominal pain (usually in the right upper or middle stomach area) and yellowing of the skin and eyes (jaundice).
- ERCP is performed on an outpatient or inpatient basis.
- Patients have to fast overnight.
- Patients are usually sedated for the procedure (eg, using midazolam) and analgesia is also given.
- Patients usually lie on their left side.
- The back of throat is sprayed with a local anaesthetic.
- The endoscope is passed down through to the stomach and then to the duodenum (where the ducts of the pancreaticobiliary system open, called Vater’s ampulla).
- Air may be pumped into the duodenum to allow better visualisation.
- Using a wire passed through the endoscope, contrast is injected through Vater’s ampulla and X-rays obtained.
- These images will indicate areas of obstruction.
- Further intervention can be performed down the endoscope if necessary – eg, stone removal, stent insertion, biopsies.
ERCP may be used to:
- Open the entry of the ducts into the bowel (sphincterotomy)
- Stretch out narrow segments (bile duct strictures)
- Remove or crush gallstones
Diagnose conditions such as biliary cirrhosis or sclerosing cholangitis
- Take tissue samples to diagnose a tumor of the pancreas, bile ducts, or gallbladder
- Drain blocked areas
Note: Imaging tests generally will be done to diagnose the cause of symptoms before an ERCP is done. These include ultrasound tests, CT scan, or MRI scan.
Risks from the procedure include:
- Reaction to the anesthesia, dye, or drug used during the procedure
- Hole (perforation) of the bowel
- Inflammation of the pancreas (pancreatitis), which can be very serious
Before the Procedure
- You will need to not eat or drink for at least 4 hours before the test. You will sign a consent form.
- Remove all jewelry so that it will not interfere with the x-ray.
- Tell your doctor if you have allergies to iodine or you have had reactions to other dyes used to take x-rays.
- You will need to arrange a ride home for after the procedure.
After the Procedure
Someone will need to drive you home from the hospital.
The air that is used to inflate the stomach and bowel during an ERCP can cause some bloating or gas for about 24 hours. After the procedure, you may have a sore throat for the first day. Soreness may last for up to 3 to 4 days.
Do only light activity on the first day after the procedure. Avoid heavy lifting for the first 48 hours.
You can treat pain with acetaminophen (Tylenol). Do not take aspirin, ibuprofen, or naproxen. Putting a heating pad on your belly may relieve pain and bloating.
The doctor or nurse will tell you what to eat. Most often, you will want to drink fluids and eat only a light meal on the day after the procedure.
Call your health care provider if you have:
- Abdominal pain or severe bloating
- Bleeding from the rectum or black stools
- Fever above 100 degrees F (37.8 degrees C)
- Nausea or vomiting