ERCP stands for “Endoscopic retrograde cholangiopancreatography”. ERCP is a type of gastric procedure that combines both upper gastrointestinal endoscopy and x-rays to treat problems of the bile and pancreatic ducts.
A Bile duct is a tube that carries bile from liver to gallbladder and duodenum. A Pancreatic duct is a tube which carries pancreatic juice from pancreas to duodenum. ERCP procedure is designed to examine diseases of the liver, bile ducts, and pancreas. Though it is not a painful procedure, in rare cases there might be some complications associated with this procedure.
In general, an ERCP is performed to diagnose the conditions of the pancreas or bile ducts and to treat those conditions as well. It is also used to evaluate the suspicious symptoms of disease in these organs or to further evaluate the abnormal results from blood tests or imaging tests such as ultrasound or CT scan.
Reasons for Suggesting ERCP:
The most common reasons why ERCP is suggested include:
- Persistent or recurrent abdominal pain which cannot be diagnosed by other tests
- Unexplained weight loss
- Blockage of bile duct either by gallbladder stones or tumours.
ERCP is also used to diagnose and treat the conditions of pancreas and bile duct such as bile duct stones and cancerous or non-cancerous tumours. It is also performed before or after the gallbladder surgery to assist the performance of the operation. Also, sometimes,the complications from a gallbladder surgery can be diagnosed and treated with ERCP.
ERCP is performed by using a long, flexible viewing instrument “a duodenoscope” of the size similar to the diameter of a pen. This duodenoscope can be directed and moved around through many bends of the stomach and duodenum. A duodenoscope have a thin bundle of fibre-optics and the light will be transmitted to the tip of the endoscope through this bundle. Also, it uses a thin wire with a chip at the tip of the endoscope which transmits the digital video images to a TV screen. The images of internal organs on a large monitor guides the doctor to carry on with the procedure.
Sometimes the ERCP is used only to diagnosis a problem. But most ERCP procedures involve treatment in addition to diagnosis. An ERCP procedure takes between 20 minutes to two hours, depending upon the treatment required.
Preparation for ERCP:
In order to reduce the complications and side effects from an ERCP, some precautionary steps need to be taken before undergoing the procedure. The doctor will review the steps with the patient to make sure that the patient knows how to get ready, and what to expect during and after the procedure. It would be better if the patient could come up with the questions regarding the procedure to the doctor if any.
To perform an ERCP, the patient’s stomach must be empty. So, the patient will be asked not to eat or drink anything for at least 8 hours before the procedure. Hence, the doctor will mention a specific time to begin fasting depending on the time of the day the procedure is scheduled.
If the patient is on any medication for other medical conditions, they need to be discussed with the doctor while planning for the procedure. Most of the medications can be continued, as usual, but some may need to be adjusted or avoided.
While preparing for an ERCP, every patient should inform the doctor about,
- allergies, if any.
- other medications and ask whether they can take them a day before and on the day of the procedure or not.
- the other medical conditions he/she suffering from such as diabetes, bleeding or blood-clotting problems, GI problems etc.
- the previous stomach or bowel surgeries
- any lung or heart-related problems that need special care during the procedure
On the day of the procedure,
- a nurse will review the patient’s medical history.
- To perform the procedure, the patient will be changed to the hospital gown.
- An IV line will be started to give the patient fluids and medicine which makes the patient feel sleepy during the procedure.
A medicine will be given to block pain and make patient relaxed and sleepy, so the patient won’t feel much pain during the procedure.
During ERCP, everything will be done to make sure that patient is at ease, safe and comfortable. In some cases the patient may feel full during the procedure, since air may be put in to help move the scope.
All blood pressure, pulse and oxygen levels of the patient will be monitored during the procedure. Back of the throat is sprayed with a liquid to numb the area to lessen the discomfort of the endoscope. A plastic bite block will be placed between your teeth to protect teeth and gums.
Once the patient is fully relaxed, the doctor will pass the endoscope carefully through the mouth that passes into the esophagus, stomach, duodenum, and the first section of the small intestine. A smaller tube is put down into the duodenum through the endoscope and can be led into the pancreatic or bile duct based on where the issue is. This smaller tube puts a special dye into the ducts.
This dye allows the doctor to see the bile ducts, pancreas and gallbladder in the X – rays. This way, the doctor can find whether the ducts are widened or narrowed or blocked. After the ERCP, the endoscope will be removed and the patient will be wake up as the medicine wears off.
Once the ERCP is finished and the source of the problem is identified, the doctor may perform one of the following procedures,
It is a procedure which involves a small incision at the opening of the pancreatic duct or bile duct. This helps to remove the small gallstones which block and restrict the drain of bile or pancreatic juice.
A stent is a small plastic tube that will be placed and left in a narrowed or blocked duct to improve drainage. While placing the stent, the narrowed duct may need to be stretched. Some stents are designed to pass out into the intestine after few weeks, while some other stents have to be removed or changed after few months.
With the help of ERCP, the gallstones can be removed from the bile duct but not from the gallbladder.
Once the ERCP is done the patient will be under observation until the medicine wears off. It is suggested to take complete rest on the day of ERCP after the procedure is completed. It is better to have an attendee who will look after the patient during the stay in the hospital. This attendee will take care of the patient as per the doctor’s instructions during pre and post-procedure.
There might be some minor issues like swelling or feeling full. Also, the patient may pass a lot of gas after the procedure. There might be soft stools or other changes in the stool of the person who underwent ERCP. Doctors will review the ERCP reports and explain the patient about medication or further treatment plan. A proper diet plan will be provided to the patient for some days until the patient will be recovered. As per the doctor’s suggestion come for the follow-up consultation.
Complications from ERCP:
In general, there are no complications associated with the procedure of ERCP, but there might be 5 to 10% of the risk for complications. Be sure to talk to the doctor about risks or any concerns. In rare cases, there might be severe complications which require the patient to get admitted to the hospital. Some of the complications from an ERCP include:
- In some cases, mild to severe swelling of the pancreas may happen which is known as acute pancreatitis. This condition needs hospitalization and sometimes surgery might be required.
- Sometimes during the procedure of ERCP, mostly while performing sphincterotomy, bleeding can happen which usually stops on its own.
- In some cases, tear or puncture of the bowel wall or bile duct can cause a problem.
- Some general infections can affect the patient, which can be treated by taking antibiotics and restoring drainage if there is a block.
In addition to these, the patient should consult the doctor immediately if he/she has any of the following symptoms:
- Severe pain in upper abdomen or back area which is not relieved by using pain medicine.
- Severe nausea
- Difficulty in swallowing
- Changes in the stool color or blood in the stool
- High fever
- Endoscopic retrograde cholangiopancreatography (ERCP) from, https://link.springer.com/article/10.1007/BF01072519
- Post-ERCP Pancreatitis: Patient and Technique-Related Risk Factors from, http://www.joplink.net/prev/200211/05.html
- Complications of diagnostic and therapeutic ERCP: a prospective multicenter study from, https://www.nature.com/articles/ajg200188
- Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study from, http://www.giejournal.org/article/S0016-5107(98)70121-X/abstract