ERCP

Endoscopic retrograde cholangiopancreatography (en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee) (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas.  The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion.  The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion.  The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine.  These ducts are sometimes called the biliary tree.  The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.  Both the biliary tree and the pancreas drain through a common opening in the small intestinal.  This common opening is called the papilla or ampulla of Vater.

ERCP is used primarily to diagnose and treat conditions of the bile or pancreatic ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.  ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted tube.  Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dye into the ducts in the biliary tree and pancreas so they can be seen on x rays.

For the procedure, you will typically lie on your abdomen on an examining table in an x-ray room.  You may be given medication to help numb the back of your throat.  A pain medication and sedative will be given intravenously to help you relax during the exam.  The physician will then guide the scope through your mouth, esophagus, stomach, and duodenum until it reaches the papilla.  Through the scope a small plastic tube will be introduced into the bile or pancreatic duct.  Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x rays.  X rays are taken as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction.  Also, tissue samples (biopsy) can be taken for further testing.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum.  These complication are relatively uncommon.

ERCP takes 30 minutes to 2 hours.  After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears off.  The physician will make sure you do not have signs of complications before you leave.  Rarely, you may need to stay in the hospital overnight.

 
Preparation
 
Your stomach and duodenum must be empty for the procedure to be accurate and safe.  You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure.  Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye.  You must also arrange for someone to take you home—you will not be allowed to drive because of the sedatives.  The physician may give you other special instructions.

Reprinted and modified from the National Digestive Diseases Information Clearinghouse.
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