for endoscopic retrograde cholangiopancreatography. As hard as this is
to say, the actual exam is fairly simple. A dye is injected into the bile
and pancreatic ducts using a flexible, fiberoptic video endoscope. Then
x-rays are taken to outline the bile ducts and pancreas.
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
Due to factors
related to diet, environment and heredity, the bile ducts, gallbladder
and pancreas are the seat of numerous disorders. These can develop into
a variety of diseases and/or symptoms. ERCP helps in diagnosing and often
in treating the condition.
ERCP is used
¨ Gallstones, which are trapped in the main bile duct
of the bile duct
jaundice, which turns the skin yellow and the urine dark
of the bile ducts or pancreas
(inflammation of the pancreas)
preparation needed before an ERCP is to not eat or drink for eight hours
prior to the procedure. Alert the physician to any blood thinners (e.g.
coumadin), aspirin, motrin, ibuprofen or similar medications you may be
taking, for these should be stopped several days prior to the procedure.
An ERCP uses
x-ray films and is performed in an x-ray room. The throat is anesthetized
with a spray or solution, and the patient is usually mildly sedated. The
endoscope is then gently inserted into the upper esophagus. The patient
breathes easily throughout the exam, with gagging rarely occurring. 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-ray films are taken. The patient lies on his or her left side
and then turns onto the stomach to allow complete visualization of the
ducts. If a gallstone is found, steps may be taken to remove it. If the
duct has become narrowed, an incision (papillotomy) can be made using
electrocautery (electrical heat) to relieve the blockage. Additionally,
it is possible to widen narrowed ducts and to place small tubing (stents)
in these areas to keep them open. The exam takes from 20 to 90 minutes,
after which the patient is taken to the recovery area. If a papillotomy
is performed, the patient is routinely admitted to the hospital overnight
for observation and discharged the following morning provided no complications
exam, the physician explains the results. If the effects of the sedatives
are prolonged, the physician may suggest an appointment for a later date
when the patient can fully understand the results.
An ERCP is
performed primarily to identify and/or correct a problem in the bile ducts
or pancreas. This means the test enables a diagnosis to be made upon which
specific treatment can be given. 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.
tests to ERCP include certain types of x-rays (CAT scan, CT) and sonography
(ultrasound) to visualize the pancreas and bile ducts. In addition, dye
can be injected into the bile ducts by placing a needle through the skin
and into the liver. Small tubing can then be threaded into the bile ducts.
Study of the blood also can provide some indirect information about the
ducts and pancreas.
mild sore throat sometimes occurs after the exam. Serious risks with ERCP,
however, are uncommon. Inflammation of the pancreas also can develop in
~ 7% of cases. There is approximately a 1% risk of excessive bleeding
and perforation, or tear in the intestinal wall, especially when electrocautery
is used to open a blocked duct. These complications may require hospitalization
and, rarely, surgery. Complications from ERCP, although rare, and can
in rare circumstances lead to death.
Due to the
mild sedation, the patient should not drive or operate machinery for six
hours following the exam. For this reason, a driver should accompany the
patient to the exam.