Gastro & Liver Care Clinic

ERCP (Endoscopic Retrograde Cholangio-Pancreatography) 
 

General information
ERCP is a sophisticated study of the bile ducts and the pancreas.  This study is the gold standard for evaluation of biliary and pancreatic abnormalities. ERCP is performed to remove gallstones in the common bile duct, evaluate the pancreas and treat gallstone pancreatitis. 

 

Reasons for exam
ERCP can be helpful in diagnosing or treating a number of conditions such as: 
 - Gallstones which are trapped in the main (common) bile duct
 - Blockage of the bile duct
 - Yellow jaundice (the skin becomes yellow)
 - Pancreatitis (inflammation of the pancreas)
 - Cancer of the bile ducts of pancreas
 - Abdominal pain of several causes

 

Preparation for the exam
You should discuss your medication with your physician prior to the procedure.  Usually, medications are not taken the morning of the procedure.  However, some medications should be taken if the procedure is to be done later in the afternoon.  Adjustments in your insulin dose should also be discussed with your physician. 

 

Equipment
The endoscope is a thin flexible lighted tube which is passed through the mouth into the upper small intestines.  It contains an optically sensitive computer chip in the tip which transmits the signal onto a video screen.  Dials permit the physician to steer the instrument in every direction.  Other instruments can be passed through the endoscope to remove stones, relieve obstructions, and perform other tasks.  The procedure is performed with the patient under an x-ray camera so that the bile ducts and pancreas can be continuously observed.  Only the most state-of-the-art equipment is used. 

 

Benefits
ERCP is the last invasive and most specific way of evaluating the bile ducts and pancreatic ducts.  It can be performed safely and with minimal discomfort.  In addition to providing a diagnosis, in many cases it allows the physician to perform specific treatment.
Frequently a sphincterotomy (papillotomy) is performed.  This procedure uses a thin wire with electrical cautery to enlarge the opening of the bile duct. Stones can be removed or a drainage tube (stent) can be placed to relieve an obstruction.

 

Risks & side effects
No test is 100% accurate and infrequently ERCP can miss abnormalities which are present.  In addition, sometimes for anatomical reasons it is not possible to inject the contrast material into the ducts.  You may have a feeling of bloating which is temporary.  Complications are very uncommon. Oversedation occurs infrequently and almost always can be reversed.  A localized irritation of the vein can occur at the IV site resulting in a tender lump which may last for several weeks.  Application of hot moist towels may relieve the discomfort.  Pancreatitis (inflammation of the pancreas) occurs in about 2-5% of cases (5-10% if sphincterotomy is required).  In most cases the pancreatitis is mild but severe cases can occur.  Other potential complications include bleeding (rarely requiring transfusion or surgery), perforation (a tear in one of the organs), infection of the bile or pancreas, worsening of underlying heart or lung disease, and adverse reaction to one of the sedatives.  Any of these complications could involve hospitalization, emergency surgery, or in an exceptionally rare case, death.