What is ERCP?
Endoscopic Retrograde Cholangiopancreatography (ERCP) is an endoscopic procedure that examines the bile ducts that drain bile from the liver into the abdomen.
ERCP is used to diagnose and treat abnormities in the bile duct such as cancerous tumors, strictures and bile leaks due to trauma or surgical injury.
ERCP used an endoscope and x-ray to examine the ductal system. The endoscopist advances the endoscope to the ampulla (opening of the bile duct into the duodenum). A catheter is pasted through the scope and into the bile duct. Contrast is injected into the ducts and x-ray images are taken to evaluate for filling defects (area where the contrast cannot flow properly) or stricture (narrowing of the bile duct). If any defects are detected, endoscopic treatments can be performed.
If stones are found, the endoscopist will attempt to remove or crush the stone. In many cases, the endoscopist will perform a sphincterotomy (a tiny cut in the sphincter to allow for passage of the stone and stone fragments or the insertion of a stent.
If solid lesions are found, biopsy can be obtained from inside the bile duct by passing forceps through the scope.
Brushings of the bile duct can be obtained for cytological evaluation and diagnosis of pancreatic cancer or cancer of the bile duct.
In the case of stricture and tumors, the endoscopist is able to insert a small plastic tube called a stent into the bile duct to keep it open and ensure that bile flows through the duct and that the duct is not compressed by a narrowing. Sphincterotomy may also be done to assist in placing the stent. ERCP will need to be repeated in 8-12 weeks to remove or replace the stent. In the case of terminal cancer, a permanent metal stent may be placed in the bile duct.
For bile duct injuries, a stent is placed to ensure that the bile flows through the duct. The stent bridges the area of the leak and keeps the bile from flowing into the abdomen. ERCP will need to be repeated in 6 to 8 weeks to remove or replace the stent and assess for healing of the leak.
What should I expect?
Upon arriving at the Endoscopy Center, you will be brought to a pre-procedures area where an endonurse will verify your allergies and medication. The endonurse will also review some medical questions with you and start an IV. The IV is necessary to administer sedation during the procedure.
Once you are ready, you will be brought to the procedure room and the gastroenterologist will explain the procedure in detail, inform you of the risks and answer any questions you may have. You will then be asked to sign a consent form.
When the procedure starts, you will be given sedation through the IV. This will make you sleepy and ensure your comfort during the procedure. A bite block will also be placed in your mouth to keep it open during the procedure, protect your teeth and prevent you from biting on the scope.
After the procedure, you will be taken to a post-procedure area where you will be observed for about one hour, or until you are awake. You will then be given something to drink and the IV will be removed so you can return home.
What are the risks?
Like any medical procedure, there are some risks. The risks of an endoscopy, although very minimal, include:
- Allergic reaction to the medication
- Risk of bleeding
- Risk of a perforation of the esophagus, stomach or duodenal wall, all of which may prompt additional surgical repair
- There is also a slight change - less than 1 percent -- of developing pancreatitis after the procedure
What can I do after the procedure?
Because of the sedation, you will be drowsy for several hours after the procedure. You are asked to refrain from driving or operating machinery for the rest of the day. You should actually just spend the rest of the day relaxing.
You can, however, resume your normal diet and activities. If you have stopped any medications prior to the procedure, you can restart them now unless otherwise instructed by your doctor.
You will be given some take-home instructions following the procedure, including a list of symptoms to watch out for. If biopsies were taken, you will be instructed to call your doctor for the results in about three working days.