Endoscopic Retrograde Cholangio Pancreatography

An endoscopic retrograde cholangiopancreatography (ERCP) is an examination of the gallbladder, pancreas, liver, and the ducts that drain these organs.

An endoscopist will examine the gallbladder, pancreas, and these ducts, looking for blockages, irregularity in the tissue or disruptions in the flow of bile/pancreatic fluid, spasm of the ducts, stones, or tumors.

The ERCP scope is a flexible tube, approximately the size of a finger. It contains a lens and a light source that allows the endoscopist to view images on a monitor where it is magnified many times so the endoscopist can see small changes in the tissues. The ERCP scope also contains channels that allow the endoscopist to take biopsies and introduce or withdraw fluid, air and instruments.

The patient will lie on an x-ray table during the examination and will be asked to swallow the tube. The scope in inserted through the mouth, and air is introduced to open up the esophagus, stomach, and intestine so the scope can be passed through those structures and to allow the endoscopist to see.

When the scope reaches the duodenum, the first portion of the small intestine, the endoscopist will locate the ampulla, the opening into the ducts that drain the biliary system. A small cannula (tube) will be placed into the ampulla and, dye will be injected through the cannula.

Patients may experience a mild discomfort as air distends the tissue. This is not harmful and belching may relieve the sensation. The endoscope does not interfere with breathing. Taking slow, deep breaths during the procedure may help a patient to relax.

The length of the examination varies, but it generally takes at least one hour.

When do you need ECRP?

Your doctor will normally recommend an ERCP if you have any of the following conditions:

• Preoperative or postoperative evaluation of patients who undergo laparoscopic gallbladder removal to detect gallstones that might be blocking the ducts,
• Evaluation of pancreatitis,
• Evaluation of a possible pancreatic cancer,
• To remove gallstones that are not passing through the ducts into the small intestine. Some stones are too large to pass easily and get stuck in the ducts,
• Evaluation of abnormal or unclear findings in the biliary system on a CT or MRI examination,
• Evaluation of chronic or acute abdominal pain when biliary disease is suspected, and
• Evaluation of jaundice (yellow skin) when bile duct disease is suspected

What are the Risks in ECRP?

ERCP is a safe procedure and serious complications are rare, but can occur:

• Pancreatitis - When it occurs, it is usually mild, causing abdominal pain and nausea, which resolves after a few days in the hospital.
• Aspiration of food or fluids into the lungs - the risk of which can be minimized by not eating or drinking for several hours before the examination.
• The ERCP scope or other instruments can cause a tear or hole in the tissue being examined.
• Bleeding can occur from biopsies or from a cut into the ampulla,
• Reactions to the medicines used for sedation,

If the doctor suspects complications, or if a drainage tube is placed into a duct or an incision made into the ampulla, the patient may be hospitalized overnight for observation.

After having the procedure, you should report the following symptoms immediately to your doctor:

• Severe abdominal pain,
• A firm, distended abdomen,
• Vomiting,
• Fever,
• Difficulty swallowing or a severe sore throat, and
• A crunching feeling under the skin.

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