Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography (ERCP) is an investigation used to view and if necessary biopsy the gallbladder, bile duct, pancreas, and pancreatic duct. Minor surgery can also be carried out during the procedure.
Preparation for an ERCP
Usually you will be lightly sedated before the outpatient procedure and will have little recollection of the event. You will usually be asked to fast for a number of hours before the procedure, to ensure that your stomach is empty. Let your doctor know if you have any allergies to antibiotics or other medicines, or intravenous contrast material. Because X-rays are used in the procedure, it's important to tell your doctor if you might be pregnant. As a sedative is used, you will need someone to take you home after the procedure - and you won't be allowed to drive until the next day.
How is ERCP performed?
In ERCP, the doctor threads an endoscope — a long, thin, flexible tube with a light at the end — down your oesophagus (gullet), through your stomach and into the duodenum. The doctor then looks through the endoscope to find the duodenal papilla (ampulla of Vater). This is the point where the pancreatic duct (from the pancreas) and the common bile duct (from the gallbladder and liver) empty their secretions into the duodenum.
After finding the duodenal papilla, the doctor will pass a small plastic tube called a catheter down through the endoscope and use this to inject special dye into the pancreatic and bile ducts. The special dye is a contrast material that shows up on X-rays which the doctor takes.
Why is ERCP done?
The X-rays can show gallstones or blockages in the bile duct and demonstrate narrowing or blockage of the pancreatic duct. ERCP may be used to help in the diagnosis of upper abdominal pain, pancreatitis and cancer of the pancreas.
If the X-rays show a gallstone in the common bile duct, the doctor can remove the stone by inserting a tiny instrument down the endoscope and making a cut through the muscle surrounding the opening of the duct (sphincterotomy). The stone is removed through the cut and collected in a tiny basket or left to pass through the intestine. The basket is removed by pulling it out through the endoscope.
A sphincterotomy will also allow the bile duct to drain more freely, or is done to insert a drainage tube called a stent. You will probably have to stay in hospital for a couple of days if you have a sphincterotomy.
Blockages and narrowing
The X-rays may show a narrowing (called a stricture) or blockage of a duct that is preventing the free flow of bile. In these cases the doctor may be able to insert a device called a stent, via the endoscope. A stent is a narrow plastic tube that is inserted into the duct to hold it open and allow the passage of bile through the duct and into the intestine in the normal way.
The doctor will also be able to take a small sample of tissue (biopsy) or fluid for analysis by the pathology lab, through the endoscope if necessary.
Risks associated with ERCP
ERCP is a common procedure which is generally safe when conducted by trained doctors. There is a small risk of complications such as pancreatitis (inflammation of the pancreas), infection, bleeding and perforation of the bowel. Some people may react to the sedative. Your doctor will discuss the risks of ERCP with you before the procedure.
If you experience any complictions after the procedure, contact your doctor or the hospital immediately. Pancreatitis, which causes severe abdominal and back pain, may occur up to 2 days after the procedure and you should contact the hospital if you have this pain.
2. NHS Choices. Gallstones. Reviewed Nov 2015. http://www.nhs.uk/Conditions/Gallstones/Pages/Treatment.aspx (accessed Feb 2016).