ERCP
ERCP stands for endoscopic retrograde cholangiopancreatography. As hard as this is to say, the actual exam is fairly straight forward. A dye is injected into the bile and pancreatic ducts using a flexible, video endoscope. Then x-rays are taken to outline the bile ducts and pancreas.
The liver produces bile, which flows through the ducts, passes or fills the gallbladder and then enters the intestine (duodenum) just beyond the stomach. The pancreas, which is six to eight inches long, sits behind the stomach. This organ secretes digestive enzymes that flow into the intestine through the same opening as the bile. Both bile and enzymes are needed to digest food.
An ERCP is performed primarily to identify and/or correct a problem in the bile ducts or pancreas. This means the test enables a diagnosis be made upon which specific treatment can be given. If a gallstone is found during the exam, it often be removed, eliminating the need for major surgery. If a blockage in the bile duct causes yellow jaundice or pain, it can be relieved.
Alternative tests to ERCP include certain types of x-rays (CAT scan, MRI) and sonography (ultrasound) to visualize the pancreas and bile ducts. In addition, dye can be injected into the bile ducts by placing a needle through the skin and into the liver. Small tubing can then be threaded into the bile ducts. Study of the blood also can provide some indirect information about the ducts and pancreas.
A temporary, mild sore throat sometimes occurs after the exam. Serious risks with ERCP, however, are uncommon. The most common complication of ERCP is called pancreatitis, an inflammation of the pancreas. It does occur in 3-5% of cases. In certain patients this risk can be higher. It results in abdominal pain and, usually, the need for hospitalization. Another risk is excessive bleeding, especially when electrocautery used to open the lower bile duct, In rare instances, a perforation or tear in the intestinal wall can occur. Surgery can be required under these circumstances.
Due to the mild sedation, the patient should not drive or operate machinery for six hours following the exam. For this reason, a driver should accompany the patient to the exam.
ERCP is an outpatient exam that is performed with the patient sedated. The procedure provides significant information upon which specific treatment can be given. In certain cases, therapy can be administered directly through the endoscope. Serious complications rarely occur from an ERCP. In each case, the physician will consider all factors and make the decision that is in the best interest of the patient.