ERCP (Endoscopic Retrograde Cholangio pancreatography)
ERCP (endoscopic retrograde cholangiopancreatography) is a procedure that is used to diagnose diseases of the gallbladder, bile system, pancreas, and liver.
What is ERCP?
Endoscopic retrograde cholangio pancreatography, or ERCP, is a specialized technique used to study the ducts of the gallbladder, pancreas and liver. Ducts are drainage routes; the drainage channels from the liver are called bile or biliary ducts. If your doctor has recommended an ERCP, this will give you a basic understanding of the procedure – how it’s performed, how it can help, and what side effects you might experience. It can’t answer all of your questions, since a lot depends on the individual patient and the doctor. Please ask you doctor about anything you don’t understand.
During ERCP, your doctor will pass an endoscope through your mouth, esophagus and stomach into the duodenum (first part of the small intestine). An endoscope is a thin, flexible tube that lets your doctor see inside your bowels. After your doctor sees the common opening to ducts from the liver and pancreas, your doctor will pass a narrow plastic tube called a catheter through the endoscope and into the ducts. Your doctor will inject a contrast material (dye) into the pancreatic or biliary ducts and will take X-rays.
Therapeutic ERCP
What is a therapeutic ERCP?
Endoscopic retrograde cholangiopancreatography, or ERCP, is a study of the ducts that drain the liver and pancreas. Ducts are drainage routes into the bowel. The ones that drain the liver and gallbladder are called bile or biliary ducts. The one that drains the pancreas is called the pancreatic duct. The bile and pancreatic ducts join together just before they drain into the upper bowel, about 3 inches from the stomach. The drainage opening is called the papilla. The papilla is surrounded by a circular muscle, called the sphincter of Oddi.
Diagnostic ERCP is when X-ray contrast dye is injected into the bile duct, the pancreatic duct, or both. This contrast dye is squirted through a small tube called a catheter that fits through the ERCP endoscope. X-rays are taken during ERCP to get pictures of these ducts. That is called diagnostic ERCP. However, most ERCPs are actually done for treatment and not just picture taking. When an ERCP is done to allow treatment, it is called therapeutic ERCP.
What happens during the ERCP procedure?
After you have received sedation (medication to make you drowsy), a gastroenterologist (a doctor who specializes in the gastrointestinal system) uses a special endoscope (a long, flexible tube with a light and camera at the end) to examine the inside of the digestive system. The gastroenterologist identifies the place where the bile duct comes into the intestine and then feeds a tiny catheter (a plastic tube) into the duct and squirts a contrast agent into the bile system (and sometimes the pancreas) while X-rays are taken. The contrast agent allows the doctors to see the ducts of the bile system, gallbladder, and pancreas on the X-rays.
The procedure is performed by using a long, flexible, viewing instrument (a duodenoscope) about the diameter of a pen. The duodenoscope can be directed and moved around the many bends of the stomach and duodenum. The modern duodenoscope uses a thin fiber-optic bundle to transmit light to the tip of the endoscope, and a thin wire with a chip also at the tip of the endoscope to transmit digital video images to a TV screen. The duodenoscope is inserted through the mouth, through the back of the throat, down the food pipe (esophagus), through the stomach and into the duodenum. Once the papilla of Vater is identified, a small plastic catheter (cannula) is passed through an open channel of the endoscope into the opening of the papilla, and into the bile ducts and/or the pancreatic duct. Contrast material (dye) is then injected and X-rays are taken of the bile ducts and the pancreatic duct. Another open channel in the endoscope also allows other instruments to be passed through it in order to perform biopsies, to insert plastic or metal stents or tubing to relieve obstruction of the bile ducts or pancreatic duct caused by cancer or scarring, and to perform incisions by using electrocautery (electric heat).
The liver is a large solid organ located beneath the right diaphragm. The liver produces bile, which is stored in the gallbladder (a small sac located beneath the liver). After meals, the gallbladder contracts and empties the bile through the cystic duct, into the bile ducts, through the papilla of Vater, and into the intestine to help with digestion. The pancreas is located behind the stomach. It produces a digestive juice that drains through the pancreatic duct–which usually joins the bile duct within the papilla,–and then enters the intestine.An important procedure related to ERCP is endoscopic ultrasonography which uses a similar endoscope that, in addition to the camera, has an ultrasound probe on its tip to examine the bile ducts, gallbladder, pancreatic duct, and pancreas ultrasonographically. Ultrasonographically-directed needle biopsies of the pancreas can be taken through a channel in the endoscope.A second, newer procedure related to ERCP is the use of miniature endoscopes that are passed through the operating channel of a duodenoscope and can be inserted directly into the bile and pancreatic ducts. The inside of the ducts can be visualized, and directed biopsies can be taken. Other therapeutic interventions also are possible.
ERCP facts
- ERCP is a diagnostic procedure designed to examine diseases of the liver, bile ducts and pancreas.
- ERCP is performed under intravenous sedation, usually without general anesthesia.
- ERCP is an uncomfortable but not painful procedure. There is a low incidence of complications.
- ERCP can provide important information that cannot be obtained by other diagnostic examinations, for example, abdominal ultrasound, CT scan, or MRI.
- Frequently, therapeutic measures can be performed at the time of ERCP to remove stones in the bile ducts or to relieve obstruction of the bile ducts.