Definition & Overview

An endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic test performed to check the ducts that are responsible for draining out the pancreas, liver, and the gallbladder. As the term implies, the test is performed using an endoscope, a thin tube with an attached lighted scope that is placed through the mouth and moved down into the abdominal region. While the main purpose of the test is to check for certain problems that affect the said organs, it can also be used to perform some treatment procedures, if necessary and possible.

Who Should Undergo and Expected Results

ERCP is recommended if the patient is experiencing symptoms such as jaundice or persistent abdominal pain that may indicate a problem with his pancreas, liver, or gallbladder. These problems include:

  • Gallstones
  • Liver disease
  • Pancreatitis
  • Narrowed bile duct


It is also beneficial for patients who suffer from some complications arising from gallstones, such as:

  • Obstruction or blockage
  • Cholangitis, or infection of the common bile duct


ERCP can be performed to:

  • Check for possible problems
  • Take a biopsy sample for further testing
  • Perform a manometry, or a simple measurement test to check the pressure inside the bile ducts
  • Perform a treatment procedure, such as removing gallstones or inserting a drain or stent through a narrowed bile duct

How is the Procedure Performed?

Before the procedure, the patient is given a local anaesthesia sprayed to the back of the throat and sedative administered intravenously into the back of the arm. The sedative will make the patient feel relaxed but completely awake throughout the procedure.

The patient is then asked to lie on his side and to swallow the first section of the endoscope. The doctor will then push the tube down through the oesophagus and into the stomach and the duodenum, or the first part of the small intestines.

At this point, the doctor begins to monitor the movement of the tube through an eyepiece or TV monitor that connects to the endoscope. Depending on the initial findings, the doctor may need to insert more instruments and tubes through the endoscope to achieve the goals of the procedure.

For example, if the test is being performed to check the health of the bile and pancreatic ducts, a special contrast dye material is injected into these ducts. The doctor then takes x-ray images of the ducts, with the dye material helping the doctor to easily detect any strictures, gallstones, or tumours that may have formed on the ducts.

On the other hand, if the test is being performed to take a biopsy sample, the doctor inserts a special instrument through the endoscope to take a small piece of tissue from the lining of the affected organ or duct.

Meanwhile, if the test shows that a gallstone obstructs the ducts, the doctor can use special instruments, such as a stent, to widen the papilla, or the opening of the bile duct, to let the stone pass through. If the narrowing or obstruction is caused by some other reason, the doctor may keep the stent in place even after the procedure.

Once the goal of the procedure has been achieved, the doctor gently pulls out the endoscope. The whole process can take anywhere between 30 minutes and an hour, depending on the initial findings and its overall scope.

Possible Risks and Complications

An endoscopic retrograde cholangiopancreatography is typically performed without any problems, other than a mild sore throat that lasts for about a day. It is also normal for patients to feel sleepy and drowsy for a few hours due to the anaesthetic and sedative used. Serious complications are very rare, although some do occur in certain cases and these include:

  • Fever
  • Breathing difficulties
  • Vomiting blood
  • Abdominal pain that gradually becomes worse over time
  • Pancreatitis, or inflammation of the pancreas



References:

  • Ulrich C.D., Martin S.P. “ERCP and Pancreatic Disease.” The National Pancreas Foundation. https://www.pancreasfoundation.org/ercp-endoscopic-retrograde-cholangiopancreatography/

  • Fogel EL., Sherman S. “ERCP for gallstone pancreatitis.” N Engl J Med 2014; 370:150-157. http://www.nejm.org/doi/full/10.1056/NEJMct1208450

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