ERCP, or endoscopic retrograde cholangiopancreatography, is an outpatient procedure performed primarily to identify a problem in the bile ducts or pancreas. Disorders found in the bile ducts, gallbladder and pancreas often result from diet, the environment and heredity. They can develop into a variety of symptoms or diseases.
ERCP can be used to check for:
- gallstones, which are trapped in the main bile duct
- blockage of the bile duct
- yellow jaundice, which turns the skin yellow and the urine dark
- undiagnosed upper-abdominal pain
- cancer of the bile ducts or pancreas
- pancreatitis (inflammation of the pancreas)
If a gallstone is found during the exam, it can often be removed, eliminating the need for major surgery. If a blockage in the bile duct causes yellow jaundice or pain, it can be relieved using ERCP.
The liver produces bile, which flows through the ducts, passes or fills the gallbladder and then enters the intestine (duodenum) just beyond the stomach. The pancreas, which is six to eight inches long, sits behind the stomach. This organ secretes digestive enzymes that flow into the intestine through the same opening as the bile. Both bile and enzymes are needed to digest food, so it is important to diagnose any problems as quickly as possible.
The actual exam is fairly simple and usually takes 20 to 40 minutes. The doctor will numb your throat with a spray or solution and usually give you a mild sedative. The endoscope is then gently inserted into the upper esophagus. A thin tube is inserted through the endoscope to the main bile duct entering the duodenum. Dye is then injected into this bile duct and/or the pancreatic duct and X-rays are taken. The physician will ask you to lie on your left side and then turn onto your stomach to allow for complete visualization of the ducts. You will be taken to the recovery area following the procedure.
An endoscope is a lighted, flexible tube with a tiny, optically sensitive computer chip at the end. As the physician moves it through the upper gastrointestinal tract, electronic signals are transmitted from the scope to a computer that displays the image on a video screen. An open channel in the scope allows other instruments to be passed through it to perform biopsies, inject solutions, or place stents.
Before an ERCP, you cannot eat or drink anything for eight hours.Your physician may ask you to stop taking certain medications, such as aspirin, before the procedure. Also, you should have someone drive you to and from the test.
After the procedure, your physician will explain the results. If the effects of the sedatives are prolonged, the physician may suggest a follow-up appointment to review the results.
You may experience a temporary, mild sore throat. The most common complication of ERCP is called pancreatitis, an inflammation of the pancreas, but that only occurs in three to five percent of cases. Pancreatitis results in abdominal pain and, occasionally, the need for hospitalization. Another risk is excessive bleeding, especially when electrocautery is used to open a blocked duct. In rare instances, a perforation or tear in the intestinal wall can occur. These complications may require hospitalization and, rarely, surgery.