What is ERCP?
Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive diagnostic and therapeutic intervention. ERCP deals with pancreatic and bile duct diseases, using endoscopic and fluoroscopic techniques.
What does it consist of?
There are three main phases:
- Phase 1. The patient lies on the left side of the fluoroscope table.
- Phase 2. The patient undergoes intravenous sedation.
- Phase 3. A camera-equipped endoscope is inserted into the duodenum through the oral cavity and esophagus. The camera allows images to be projected onto a screen for the physician to view. The endoscope is also used to inject contrast fluid into the duodenum for fluoroscopy.
ERCP can be performed for therapeutic purposes.
Why is it performed?
The diagnostic indications in which endoscopic retrograde cholangiopancreatography may be necessary are the following:
- The patient has already had other diagnostic tests such as ultrasound and CT scans, which have confirmed the existence of gallstones or pancreatic cancer.
- The patient has obstructive jaundice: if the bile is obstructed in its passage into the duodenum and stagnates in the liver, a pigment contained in the bile and called bilirubin can be released into the blood, causing obstructive jaundice to appear.
- The patient is affected by pancreatitis, which may be acute or chronic; in the first case the symptoms arise suddenly, while in the second case the inflammation is progressive. When pancreatitis becomes very severe, it can lead to the destruction of the pancreas itself.
- Appearance of gallstones or gallbladder stones.
- Pancreatic cancer of malignant or benign nature, due to proliferation of exocrine or endocrine cells of the pancreas.
- The patient has a pancreas divisum, a condition in which the pancreas divides in two instead of having a unitary duct.
- A sample of pancreatic tissue or bile duct cells should be taken and biopsied; removal of tissue for biopsy is extremely helpful in confirming the presence of a tumor in the bile ducts or pancreas;
If cholangiopancreatography is used for therapeutic purposes, the applications of this technique are as follows:
- To remove remove bile duct stones from the biliary tract.
- For biliary stenting, i.e. the insertion of stents in bile ducts to resolve a narrowing of a bile duct.
- To resolve a stricture of the bile ducts.
- To perform endoscopic sphincterotomy for preventive purposes to avoid possible complications that may arise as a consequence of cholecystectomy.
Preparing for ERCP
To prepare for ERCP, follow these guidelines:
- Conduct an objective discussion with your physician to gather the patient’s anamnesis, medical and family history.
- Perform other diagnostic tests such as blood tests, electrocardiogram and blood pressure measurement.
- It may be necessary to stop taking certain types of medication a few days before the test.
- The doctor may ask the patient to take a course of antibiotics for preventive purposes.
- Show up for the test after fasting for 8 hours.
How do you feel during the test?
Local anesthesia may make you feel like you can’t breathe when the endoscope is inserted through your mouth, but the airflow is not actually impeded in any way.