Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography (ERCP) is a study used to evaluate the ducts that drain the liver and pancreas. ERCP is used primarily to manage and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.
Stones passing form the gallbladder or stone formation within the bile duct, other causes of biliary obstruction include tumors, injury from gallbladder surgery, or inflammation, can obstruct the bile duct. The bile ducts may also become narrowed (called a biliary stricture) as a result of cancer, blunt trauma to the abdomen, pancreatitis (inflammation of the pancreas. Patient with an obstructed bile duct can develop cholangitis, which is an infection of the bile ducts caused by bacteria or parasites. ERCP can also be used to diagnose a number of pancreatic disorders including the diagnose of cancer of the pancreas; pancreatic pseudocysts (collections of pancreatic fluid); or strictures of the pancreatic ducts. Certain congenital disorders may also be identified by ERCP, such as pancreas divisum, a condition in which parts of the pancreas fail to fuse together during fetal development. ERCP can also be used to treat certain types of strictures present in the pancreatic duct as a result of conditions such as chronic pancreatitis. The pancreas is an organ that secretes pancreatic juice into the upper part of the intestine. Pancreatic juice is composed of specialized proteins that help to digest fats, proteins, and carbohydrates. Bile is a substance that helps to digest fats; it is produced by the liver, secreted through the bile ducts, and stored in the gallbladder. Bile is released into the small intestine after a person has eaten a meal containing fat.
In endoscopic retrograde cholangiopancreatography, an endoscope is introduced into the patient’s mouth and fed through the esophagus, stomach, and duodenum (small intestine). Using special catheters dye is released into the ducts and a series of x rays is taken, as a result stones or tumor may become visible.
Before undergoing ERCP, the patient will be instructed to refrain from eating or drinking for at least 8 hours to ensure that the stomach and upper part of the intestine are empty. Arrangements should be made for someone to take the patient home after the procedure, as he or she will not be able to drive. The physician should also be given a complete list of all prescription, over-the counter, and alternative medications or preparations that the patient is taking. The patient should also notify the doctor if he or she is allergic to iodine because the contrast dye contains it.
Risks Complications that have been reported with ERCP include pancreatitis, cholangitis (inflammation of the bile ducts), cholecystitis (inflammation of the gallbladder), and injury to the duodenum, pain, bleeding, infection, and formation of blood clots. Factors that increase the risk of complications include liver damage, bleeding disorders, a history of post-ERCP complications, and a less experienced endoscopist. The overall complication rate associated with ERCP is approximately 11%. Pancreatitis may occur in up to 7% of patients. Cholangitis and cholecystitis occur in less than 1% of patients. Infection, injury, bleeding, and blot clot formation also occur in less than 1%. The mortality rate for ERCP is approximately 0.1%.