Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines endoscopy and fluoroscopy to diagnose and treat disorders associated with the pancreatic and biliary ductal systems as well as the liver, gallbladder, and pancreas.

Endoscopy is a medical procedure in which an endoscope – a thin, long, flexible tube with a light and tiny camera at one end – is inserted into the body to examine an internal organ or tissue in detail.

Fluoroscopy is a medical imaging technology that uses radiography or a continuous X-ray beam passing through your body to produce real-time moving images of a body part being examined on a monitor.

Disease Overview

Pancreatobiliary disorders are conditions or abnormalities of the pancreas, bile ducts, or gallbladder. The different types of disorders that may occur in these structures include obstruction, leakage, inflammation, stone formation, and tumors or lesions, resulting in a variety of gastrointestinal problems.

Indications

Your physician may recommend ERCP for the diagnosis and treatment of the following pancreatobiliary conditions:

• Treating blockages in the bile or pancreatic ducts due to gallstones, strictures, cancer, or compression from nearby tissues
• Jaundice (yellowish skin due to blockage of the bile duct)
• A tumor or lesion in the pancreas, gallbladder, or liver
• Pancreatitis or inflammation of the pancreas
• To confirm diagnosis of pancreatic or bile duct cancer and plan treatment
• Persistent or recurrent upper abdominal pain which cannot be diagnosed by other tests such as MRCP/MRI and CT

Preparation

Preoperative preparation for ERCP may involve the following steps:

• A thorough history and physical examination
• Routine blood work and imaging
• Informing your doctor of any medications or supplements you are taking
• Refraining from blood thinners, aspirin, or NSAIDs, if indicated
• Informing your doctor of any allergies to medications, anesthesia, or contrast dye
• Refraining from solids or liquids at least 8 hours prior to the procedure
• Arranging for someone to drive you home after the procedure

Surgical procedure

In general, endoscopic retrograde cholangiopancreatography will involve the following steps:

• You will be asked to lie on an examination table for the procedure.
• The procedure may be performed under sedation and local anesthesia or general anesthesia. An intravenous (IV) needle will be placed in your arm.
• After administering a local anesthetic to the throat, your doctor will insert an endoscope through your mouth, esophagus, and stomach to reach the first part of the intestine called the duodenum where the bile and pancreatic ductal systems open.
• A small camera mounted on the endoscope captures images which are magnified and viewed on a monitor.
• Your doctor will locate the opening where the bile and pancreatic ducts empty into the duodenum.
• A catheter will be inserted through the endoscope into the ducts and a special dye, called a contrast medium, will be injected into the ducts through the catheter to make them more visible on x-rays.
• Fluoroscopy (live X-ray imaging) is performed to identify any areas of blockage or other abnormalities.
• Your doctor may then pass tiny tools through the endoscope to open blocked or narrowed ducts, remove or break up gallstones, or excise lesions.
• Temporary stents may be inserted to keep the ducts open or to avoid bile leaks that can occur after gallbladder surgery.
• The procedure often takes between 1 and 2 hours.

Postoperative care

In general, postoperative care and recovery will involve the following:

• You will be transferred to the recovery area and monitored until the anesthesia wears off.
• Once your vital signs are stable and you are alert, you will be transferred to the hospital room or discharged home.
• You may experience nausea or bloating for a short duration after the procedure.
• You may have some soreness or irritation in the throat for a day or two.
• Medications are provided as needed to address the symptoms associated with the procedure.
• Dietary instructions may include eating a soft diet until the soreness subsides and consuming plenty of liquids.
• You may resume your usual diet and normal activities in a couple of days following the procedure.

Risks and Complications

Some of the risks and complications of endoscopic retrograde cholangiopancreatography include:

• Infection
• Inflammation of the pancreas or gallbladder
• Excessive bleeding
• Duct perforation or damage to the small intestine, esophagus, or stomach
• Allergic/anesthetic reactions

Summary

Endoscopic retrograde cholangiopancreatography (ERCP) is an outpatient (same-day) procedure. The procedure offers crucial information on specific treatment for any disorders associated with the pancreatic and biliary ductal systems, as well as the liver, gallbladder, and pancreas. In some instances, treatment can be delivered right through the endoscope. ERCP is a safe procedure and serious complications are rarely noted.