Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is used to detect and treat conditions of the bile ducts, such as stones, narrowings (strictures), leaks (from trauma and surgery), and cancer. ERCP is performed mostly with a therapeutic intention.

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 bile ducts and pancreatic duct so they can be seen on x- ray.

Why do I need ERCP?

To find out the cause of blockage of the bile duct:

1. Diseases of the bile ducts

  • Bile duct stones
  • Bile duct tumors
  • Suspected injury to bile ducts

2. Diseases of the pancreas

  • Pancreatic tumors
  • Chronic pancreatitis

3. Treatment of the diseases

  • Endoscopic sphincterotomy (enlargement of the opening of the ampulla)
  • Removal of bile duct stones
  • Insertion of stent(s) (tubes)
  • Dilation (opening) of bile duct narrowing

Are there any Contraindications?

1. Absolute contraindication:

  • The patient that is not able to cooperate.

2. Relative contraindications

  • Recent heart attack.
  • History of allergy to dye (contrast).
  • Frail and unfit for surgery.
  • Severe heart and lung disease.

Procedure

The procedure is done under the sedation which will make you comfortable during the procedure. A flexible camera (endoscope) is inserted through the mouth, passed the stomach into duodenum until it reaches the ampulla of Vater. A plastic catheter or cannula is inserted through the ampulla, and dye is injected into the bile ducts, and/or, pancreatic duct. X-ray is used to look for stones, blockages, or other lesions.

When needed, the opening of the ampulla can be enlarged with an electrified wire (sphincterotome) and access into the bile duct obtained so that stones may be removed or other therapy performed.

Stones from the bile ducts are removed with a basket or balloon. Other procedures during ERCP include insertion of a plastic stent to assist in the drainage of bile. The pancreatic duct can also be accessed and stents inserted.

Preparation

Stomach and duodenum must be empty for the procedure to be accurate and safe. You should not eat or drink after midnight, before the procedure, or for 6 to 8 hours beforehand, depending on the time of the procedure. Your doctor need to know whether you have any allergies, especially to iodine, which is in the dye and whether you are taking any blood thinners, warfarin, clopidogrel and aspirin.

Risks

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), which can occur in up to 7%* of all procedures.

Gut perforation (0.1-0.3%*) is a risk of any endoscopic procedure, and is an additional risk if a sphincterotomy is performed. Sphincterotomy is also associated with a risk of bleeding (0.8-2%*). *ASGE Guidelines

Other risks may be related to sedation and contrast dye, but these are rare.