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Endoscopic Retrograde Cholangiopancreatography (ERCP)

Overview

ERCP is a medical examination of the digestive system which combines endoscopy with X-ray imaging. In this examination, a flexible tube called endoscope is inserted through the mouth and into the upper digestive tract. This allows the physician to inject dye into the bile and pancreatic ducts for clear X-ray imaging. It is used for diagnosing and treating conditions related to the gallbladder, bile ducts and pancreas.

An ERCP may be suggested by your doctor in the following cases:

  • Gallstones and Bile Duct Blockage: In case there is a suspicion of gallstones being trapped in the bile duct, an ERCP may be recommended. ERCP can also identify and relieve other blockages in the bile duct that may cause jaundice or pain.
  • Yellow Jaundice: ERCP may help to determine the cause of yellowing of the skin and dark urine, often related to bile duct issues.
  • Pancreatitis: in case of pancreatitis, ERCP is helpful for diagnosing the level of inflammation of the pancreas. It can also help to identify the cause of pancreatitis.
  • Pancreatic or Bile Duct Cancer: ERCP can help detect cancer in the bile ducts or pancreas.
  • Infections: ERCP is also used to identify and treat infections within the bile ducts.
  • Leaks in the Bile or Pancreatic Ducts: In cases where leaks in the bile or pancreatic ducts are suspected, ERCP is recommended for identifying and addressing these issues.

The preparation for ERCP typically involves fasting where the patient is asked not to eat or drink for up to 8 hours prior to the procedure In some cases, the patient may also be asked to stop certain medications, especially blood thinners.

ERCP is usually performed in a room equipped for X Rays. The procedure follows these steps:

  • The patient is first positioned on his/her left side, with his/her head turned to the right.
  • A mild sedative is administered to help the patient relax and remain comfortable.
  • A flexible tube (endoscope) is gently inserted through the patient's mouth and into the upper digestive tract.
  • A thin tube is then inserted through the endoscope to inject dye into the bile ducts. After this, X-rays are taken to visualize the ducts.
  • If necessary, gallstones are removed, blockages cleared, or stents placed to keep the ducts open. Electrocautery is used to make an incision in the bile duct. It is a technique that uses heat generated by an electric current to cut tissues.
  • The procedure typically lasts between 20 to 40 minutes, but it may take longer depending on its complexity.

The positive outcomes of ERCP include:

  • ERCP can identify the cause of symptoms related to the bile ducts and pancreas, such as gallstones or blockages.
  • It allows some immediate treatments, such as removing gallstones or placing stents, reducing the need for major surgery.
  • It can help relieve symptoms like jaundice and pain caused by bile duct blockages with some immediate interventions.

  • Endoscopic Ultrasound (EUS): Uses sound waves to image the bile ducts and pancreas.
  • Percutaneous Transhepatic Cholangiography (PTC): A needle is used to inject the dye into the bile ducts through the skin.
  • Magnetic Resonance Cholangiopancreatography (MRCP): an MRI to visualize bile and pancreatic ducts.
  • Ultrasound

Common side effects of ERCP may include:

  • Sore Throat: A mild, temporary sore throat may occur due to the insertion of the endoscope.
  • Pancreatitis: in rare cases, there is a risk of inflammation of the pancreas due to the close proximity of pancreas with the bile duct.
  • Bleeding: Minor bleeding can occur if an incision is made during the procedure.
  • Infection: There is a risk of infection in very rare cases.
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