ERCP

ERCP is an abbreviation of a very complicated name "endoscopic retrograde cholangiopancreatography". This examination has a great importance for gastroenterologists. It can identify and therapeutically solve many disease of the biliary tract and pancreas.

Principle

ERCP is an endoscopic method, which aims to examine the bile duct and pancreatic duct. On first sight, it may seem to be somewhat similar to upper GI endoscopy – the patient is in horizontal position and the endoscopic device (flexible hose-like device with video camera and light source) is inserted into the mouth and through the esophagus and stomach into the duodenum.

 

However, there are some important differences. The examination lasts much longer than classic upper GI endoscopy and it may be quite unpleasant. Therefore, a tranquilizer is usually administered to make the procedure more comfortable. The endoscopic device is inserted into the duodenum, but it is equipped with side optics, so the doctor directly sees the wall of the gastrointestinal tract. In the duodenum, the examiner must found the papilla of Vater where is located the common opening of bile ducts and pancreatic duct. When this place is found, the doctor tries to insert a thin wire into the opening and fill the ducts with contrast agent. When this happens, an X-ray is activated to show the contrast flow. The contrast shows us anatomy of the biliary tract and pancreatic duct and any obstructions or narrowing. In addition, it allows to insert many tools to perform basic examination and therapeutic methods (cutting the papilla of Vater, remove gallstones, insert a stent to dilate the bile duct, take samples for cytological examination, etc.).

 

ERCP

 

Scheme - the endoscopic device in the duodenum successfully examines the bile duct (red)

 

After the intervention, it is advisable to hospitalize the patient, monitor vital signs and take basic blood samples to rule out irritation of pancreas and post-ERCP acute pancreatitis. After the procedure, the patient should not eat. Some departments allow the patient to drink, other give fluids only in infusions. It is necessary to prevent dehydration as it significantly increases the risk of acute pancreatitis. When the blood tests are repeatedly satisfactory, the patient is allowed to eat.

Preparation

The preparation is similar to upper GI endoscopy, the patient should not eat or drink approximately 6 hours before the examination. In addition, the procedure may cause local bleeding and therefore, anticoagulant medications should be discontinued when possible (and only when indicated by a doctor).

Indications

The ERCP is used in diagnosis and therapy of obstructions of biliary tract and pancreatic diseases. Gallstones can be visualized and removed. When the bile flow is obstructed by a suspected local cancer (pancreatic cancer, bile duct cancer, gallbladder cancer), it is possible to obtain local cell samples for cytological examination and dilate the narrowing by a special tube-shaped stent. This does not cure the tumor, but it allows the bile to flow and significantly increases the patient's quality of life. ERCP is also used in diagnosis of chronic pancreatitis and its complications.

Disadvantages

The procedure may last for a longer time and it can pose a significant load on both the patient and examiner. ERCP may cause local bleeding from the biliary tract, local injuries, digestive problems and acute pancreatitis.

Advantages

Diagnostic ERCP may be partially replaced by less invasive abdominal ultrasound, computed tomography, or MRCP. However, only ERCP allows to take samples for cytological examination and therapeutically solve many pathologies.