ERCP

Answer 1

Definition

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to identify stones, tumors, or narrowing in the bile ducts. The procedure is done through an endoscope.

Alternative Names

Endoscopic retrograde cholangiopancreatography; Papillotomy; Endoscopic sphincterotomy

How the test is performed

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, and passed through the esophagus (food pipe) and stomach until it reaches the duodenum (the part of the small intestine that is closest to the stomach).

A catheter (thin tube) 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 to

• Open the entry of the ducts into the bowel
• Stretch out narrow segments
• Remove or crush stones
• Take tissue samples
• Drain blocked areas

How to prepare for the test

You will need to fast at least 4 hours before the test and sign a consent form. Remove all jewelry so that it will not interfere with the x-ray.

How the test will feel

Because of the intravenous sedation, you may not feel any discomfort, and may have no memory of the test. There may be some gagging as the tube is passed down the esophagus. As the scope is positioned, there will be some stretching of the stomach and duodenum. Occasionally, stretching of the ducts can be felt.

Air, used to inflate the stomach and bowel, can cause some bloating or gas. After the procedure, you may have a sore throat for 3 to 4 days. Some people have a bad reaction to the dye or the drugs used to relax the duodenum, which can cause symptoms like nausea, hives, burning sensation, blurred vision, and urine retention.

Why the test is performed

The procedure is used to identify any 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). These include:

• Bile duct strictures
• Bile duct tumors
• Chronic pancreatitis
• Gallstones
• Primary biliary cirrhosis
• Cholangitis
• Pancreatic pseudocysts
• Pancreatic strictures
• Pancreatic tumors (including pancreatic cancer)

ERCP is often performed after gallstones in the common duct are discovered during cholecystectomy.

A procedure called endoscopic sphincterotomy (ES) can be done at the same time as an ERCP.

Normal Values

The x-ray will show normal structures for the age of the patient.

What abnormal results mean

Abnormal results may indicate stones or narrowing of the ducts, presence of tumors, cancer, cirrhosis (severe liver disease), and cysts(abnormal cavity filled with fluid or half-solid substances).

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

What the risks are

Reactions to the anesthesia, dye, or drug used during this procedure may include

• Blurred vision
• Breathing problems
• Dry mouth
• Feeling of burning or flushing
• Hives
• Low blood pressure or slow heart rate
• Nausea
• Throat spasm
• Urine retention

Risks related to the procedure include:

• Bleeding
• Perforation (hole) of the bowel
• Inflammation of the pancreas (pancreatitis), which can be very serious

Long-term complications include:

• Return of stones
• Abscess

ReferencesPasricha PJ. Gastrointestinal endoscopy. In: Goldman L, Ausiello D, eds.Cecil Medicine.23rd ed. Philadelphia, PA: Saunders Elsevier; 2008:chap 136.

Answer 2

Definition

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to identify stones, tumors, or narrowing in the bile ducts. The procedure is done through an endoscope.

Alternative Names

Endoscopic retrograde cholangiopancreatography; Papillotomy; Endoscopic sphincterotomy; ERCP

Description

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 is passed 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 any discomfort and may have little or no memory of the test. You may gag as the tube is passed down your esophagus. As the scope is in place, there will be some stretching of the stomach and duodenum. You may feel stretching of the ducts.

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 any 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 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
• Take tissue samples to diagnose a:
  • Tumor of the pancreas, bile ducts, or gallbladder
  • Conditions called biliary cirrhosis or sclerosing cholangitis
• 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

Reactions to the anesthesia, dye, or drug used during this procedure may include:

• Blurred vision
• Breathing problems
• Dry mouth
• Feeling of burning or flushing
• Hives
• Low blood pressure or slow heart rate
• Nausea
• Throat spasm
• Problems emptying your bladder (urine retention)

Risks from the procedure include:

• Bleeding
• Hole (perforation) of the bowel
• Inflammation of the pancreas (pancreatitis), which can be very serious

Before the Procedure

You will need to fast for at least 4 hours before the test and 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, which may last for up to 3 - 4 days.

Stick to 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

References

Kimmey, MB. Complications of gastrointestinal endoscopy. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 40.

Reviewed By

Review Date: 08/11/2011

George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA,Medical Director, A.D.A.M., Inc.

Answer 3

ERCP stands for Endoscopic Retrograde Cholangiopancreatography, a procedure used to diagnose and treat conditions affecting the bile ducts and pancreas. It involves passing an endoscope through the mouth into the digestive tract to inject contrast dye and visualize these structures on X-ray. ERCP can also be used to remove gallstones, place stents, or collect tissue samples for biopsy.