Gastroenterologists

Who needs ERCP ?

  • Individuals with stones, tumors, strictures or other abnormalities of the bile ducts, gall bladder, or pancreas
  • Individuals with evidence of blockage of the bile duct identified by ultrasound, CT scan or other diagnostic test
  • Individuals with unexplained recurrent pancreatitis
  • Individuals with unexplained jaundice
  • Individuals with unexplained abnormalities of liver chemistries
  • Individuals being considered for liver transplantation

What is ERCP ?

ERCPERCP or Endoscopic Retrograde Cholangio Pancreatography is a technique in which the gallbladder, bile ducts, and pancreatic ducts are injected with x-ray dye and x-ray pictures are taken. When these x-ray pictures show stones or obstructions, they can often be treated during the same ERCP examination. Thus, ERCP is a useful method for both diagnosis and treatment, but it is complex and can result in complications. It is important to understand exactly what is being proposed, the potential benefits and risks, and alternative methods which might be used.


How is ERCP performed?

Pre-Preparation is same as for Upper GI Endoscopy.

Doctor may require some additional blood tests to be done before the procedure. ECRP is done under Anesthesia/Sedation. Hence patient requires to stay back post procedure for observation for few hours or a day.

Procedure is essentially performed as same way as upper GI endoscopy. However endoscope used here has side view rather than end view facility & is little thicker in diameter. The procedure take 30 90 minutes.

Possible ERCP Treatments

If x-rays show a blockage of the papilla or the duct systems, the doctor may be able to treat it immediately. Common treatments include sphincterotomy, balloon dilatation (stretching), stenting, and placement of drainage tubes.

  • Sphincterotomy
    Means cutting the muscular sphincter of the bile duct or pancreatic duct. A small cut (about 1/4 inch long) is made in the papilla to enlarge the opening. This cut is made with electrical current (which you do not feel), so as to cauterize the tissues to prevent bleeding.
  • Stone removal
    The most common reason for performing a biliary sphincterotomy (cutting the opening of the bile duct) is to remove bile duct stones. Although stones can pass spontaneously after a sphincterotomy into the duodenum (and through the intestines), doctors usually remove them directly at the same time using a basket-shaped grasper or by sweeping the duct with a small balloon on the end of a catheter. Large stones may need to be crushed before removal, a technique called lithotripsy. Special devices such as lasers may be needed occasionally to break particularly hard stones. Stones can also be removed from the pancreatic ducts, but they are often harder, and technically more difficult to remove.
  • Papillary stenosis and sphincter dysfunction.
    Sphincterotomy (of the bile duct and/or pancreatic orifice) is used also when there is scarring of the papilla (papillary stenosis) or evidence of overactivity (spasm) of the muscular valve. This is called sphincter of Oddi dysfunction. Sphincterotomy is more hazardous in this context than when used for stones.
  • Duct dilatation and stenting.
    ERCP x-rays may show partial blockage or narrowing of the bile duct or pancreatic duct. This narrowing can be stretched (dilated) using a sausage shaped balloon catheter. Often a small tube (stent) is left behind to maintain the stretch, and allows the duct to drain more easily.
  • Nasobiliary drainage.
    Sometimes, instead of a plastic stent which stays in the duct, the doctor will choose to leave a longer tube for drainage after ERCP. This is also placed through the endoscope during ERCP, but the end of the tube comes out through your nose after the procedure is finished. The tube may be a little uncomfortable, but you will be able to eat and drink normally while it is in place (usually for one to three days).