Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure used to identify the presence of gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), tumors, cancer , or narrowing in the biliary and pancreatic ducts. After the endoscope is properly placed, a catheter is advanced which will inject a contrast agent through the ducts. The contrast is visible on X-rays, and allows a physician to evaluate the caliber, length and course of the ducts. An ERCP may be performed if a patient experiences symptoms such as jaundice, abdominal pain, fever, or malabsorption.

 

The procedure is used to identify any abnormality of the pancreas or bile ducts that can cause abdominal pain, jaundice, fever, or malabsorption. These include:
•  Bile duct strictures
•  Bile duct tumors
•  Chronic pancreatitis
•  Gallstones
•  Pancreatic pseudocysts
•  Pancreatic strictures
•  Pancreatic tumors (including pancreatic cancer)

Additional conditions under which the test may be performed:
•  Biliary obstruction
•  Biliary stricture
•  Cholangiocarcinoma
•  Cholangitis
•  Choledocholithiasis
•  Cholelithiasis
•  Chronic pancreatitis
•  Pancreas divisum
•  Pancreatic carcinoma
•  Primary biliary cirrhosis
•  Sclerosing cholangitis

Details of the procedure

The patient is often sedated or anaesthetized. Sometimes a spray to numb the throat is also used.

After the sedative takes effect, the endoscope is inserted through the mouth into the duodenum (the portion of the small intestine that is closest to the stomach).

A catheter (thin tube) is advanced through the endoscope and inserted into the pancreatic or biliary ducts. A special dye is injected into these ducts and x-rays are taken to evaluate them. Narrowing, stones, and tumors can be identified.

Special instruments can be placed through the endoscope and into the ducts to open the entry of the ducts into the bowel, stretch out narrow segments, remove or crush stones, take tissue samples, and drain obstructed areas.

Other procedures associated with ERCP include the trawling of the common bile duct with a basket or balloon to remove gallstones and the insertion of a plastic stent to assist the drainage of bile. Also, the pancreatic duct can be cannulated and stents be inserted. The pancreatic duct requires visualisation in cases of pancreatitis.

In specific cases, a second camera can be inserted through the channel of the first endoscope. This is termed duodenoscope-assisted cholangiopancreatoscopy (DACP) or mother-daughter ERCP. The daughter scope can be used to administer direct electrohydraulic lithotripsy to break up stones, or to help in diagnosis by directly visualizing the duct (as opposed to obtaining X-ray images).

Risks and Complications

Side effects from the dye, and from the drug used to relax the duodenum. These side effects may include nausea, hives, blurred vision, a dry mouth, a feeling of burning or flushing, and retention of urine.
•  Reaction to anesthesia
•  Bleeding
•  Perforation (hole) of the bowel
•  Pancreatitis (an inflammation or infection of the pancreas)

Cost of the procedure

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Image source: Medline Plus