Endoscopic Retrograde Cholangiopancreatography (ERCP) is a technique that combines the usage of X-ray together with the endoscope to examine anatomical strucures that drain the liver, gall bladder and pancreas. It is used to provide important information that cannot typically be obtained by other diagnostic examinations, such as an abdominal ultrasound, CT scan or MRI. Your healthcare provider guides the scope through your mouth and throat, then down the esophagus, stomach, and the first part of the small intestine (duodenum). Your healthcare provider can view the inside of these organs and check for problems.
ERCP is performed to treat and diagnose problems belonging to biliary tract or pancreas such as gallstones, inflammatory strictures or scars, and cancer. ERCP may be used to remove or crush gallstones, check persistent abdominal pain or jaundice, open the entry of the ducts into the bowel, stretch out narrow segments, take tissue samples or drain blocked areas.
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During the procedure, an intravenous (IV) line is placed in your arm and a medication will be given to relax or sedate you. You will lie on your stomach or on your left side. A spray to numb the throat will be administered and a mouth guard will be placed in your mouth to protect your teeth. After the sedatives take effect, an endoscope is inserted into your mouth. You should not feel discomfort and may have little memory of the test. A thin tube is passed through the endoscope and inserted into the ducts that lead to the pancreas and gallbladder. A special dye is injected into these ducts and X-rays are taken. This helps the doctor see stones, tumors and any areas that have become narrowed.
You will undergo a blood test before the procedure. You will be asked to fast after midnight on the night before and should not eat at least 6-8 hours before the procedure. Drinking water should be stopped 4 hours before the procedure. Medication that should be avoided include; aspirin, NSAIDs, Insulin, Antacids. Your doctor will check your history and any important matter prior to the procedure
After the procedure, you will need to have someone drive you home. Drink fluids and eat light meals right after your procedure. You’ll notice some bloating or gas for about 24 hours after the procedure and may have a sore throat for a few days. Use a heating pad or acetaminophen to relieve pain and bloating. Avoid heavy lifting for the first 48 hours after your procedure. Call your doctor if you have abdominal pain or severe bloating, bleeding from the rectum, black stools, fever or nausea/vomiting.
Risks of ERCP include: 1. Inflammation of the pancreas (pancreatitis) or gallbladder (cholecystitis). Pancreatitis is one of the most common complications and should be discussed with your provider ahead of time. Keep in mind, though, that ERCP is often performed to help relieve the disease in certain types of pancreatitis. 2. Infections 3. Bleeding 4. Perforation tear in the lining of the small intestine, esophagus, or stomach 5. Biloma - Collection of bile outside the biliary system (biloma)
What is the difference between an ERCP and MRCP?
ERCP is an invasive procedure where an incision is required on the body whereas MRCP is non-invasive i.e. done externally utilizing a machine that generates a magnetic field. An ERCP involves inserting an endoscope with a camera attached at one end, through the mouth until the pancreas and then viewing the inside of the gastrointestinal tract with the help of fluoroscope. Once the endoscope reaches passes stomach and reaches the gall bladder, a dye is injected into the duct of the pancreas and viewed through a fluoroscope. The endoscope and the fluoroscope combined allow the physician to view the inner aspects of the stomach, pancreas and the duodenum.