ERCP is a diagnostic test to examine the duodenum (the first portion of
the small intestine), the papilla of Vater (a small nipple-like
structure with openings leading to the bile ducts and the
pancreatic duct), the bile ducts, the gallbladder and the pancreatic duct. The procedure
is performed by using a long, flexible, viewing instrument (a
duodenoscope) about the diameter of a pen. The duodenoscope is flexible
and can be directed and moved around the many bends of the stomach and
intestine. Two types of duodenoscopes are currently available. A
fiber-optic duodenoscope uses a thin fiber-optic bundle to transmit images
to the lens at the viewing end of the instrument. A videoscope uses a thin
wire with a chip at the tip of the instrument to transmit images to a TV
screen. The duodenoscope is inserted through the mouth, to the back of the
throat, down the food pipe, through the stomach and into the first portion
of the small intestine (duodenum). Once the papilla of Vater is
identified, a small plastic catheter (cannula) is passed through an open
channel of the duodenoscope into the papilla of Vater, and into the bile
ducts and/or the pancreatic duct. Contrast material (dye) is then injected
and x-rays are taken of the bile ducts and the pancreatic duct. The open
channel also allows other instruments to be passed through it in order to
perform biopsies, to insert plastic or metal tubing to relieve obstruction
of bile ducts caused by cancer or scarring, and to perform incision by
using electrocautery (electric heat). For further information on the
anatomy and physiology of bile production (by the liver) and circulation,
please visit the Gallstones article.
The liver is a large solid organ located beneath the right diaphragm.
The liver produces bile, which is stored in the gallbladder (a small sac
located beneath the liver). After meals, the gallbladder contracts and
empties the bile through the cystic duct, into the bile ducts, through the
papilla of Vater, and into the intestine to help with digestion. The
pancreas is located behind the stomach. It also produces digestive juice
which drains through the pancreatic duct into the papilla of Vater, and
into the intestine.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
Pancreatitis is a rare disease in which the pancreas becomes inflamed, occurring when digestive enzymes are activated and begin attacking the pancreas causing damage to the gland. There are two types of pancreatitis, acute and chronic. Most commonly caused by alcohol or gallstones, it can lead to bleeding in the gland, serious tissue damage, infection, and cysts. Enzymes and toxins may then enter the bloodstream and seriously injure organs, such as the heart, lungs, and kidney.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Gallbladder cancer is a rare form of cancer with symptoms that include jaundice, abdominal pain, fever, nausea and vomiting, abdominal lumps, and bloating. Risk factors include being female and Native American. Treatment of gallbladder cancer depends upon the stage of the cancer, the type of gallbladder cancer, and whether the cancer can be removed by surgery.
Primary sclerosing cholangitis (PSC) is a chronic, progressive disease of the bile ducts that channel bile from the liver into the intestines. There is an association between primary sclerosing cholangitis and ulcerative colitis and Crohn's disease. Symptoms of primary sclerosing cholangitis include abnormal liver blood tests, itching, fatigue, and jaundice. Primary sclerosing cholangitis is treated with medications and in some cases, liver transplant.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Pancreas divisum is a common congenital anomaly (an anomaly that is present at birth) of the pancreatic duct(s). The human embryo starts life with two ducts in the pancreas; the ventral duct and the dorsal duct. In more than 90% of the embryos, the dorsal and the ventral ducts will fuse to form one main pancreatic duct. In approximately 10% of embryos, the dorsal and the ventral ducts fail to fuse. Failure of the ventral and the dorsal pancreatic ducts to fuse is called pancreas divisum (because the pancreas is drained by two ducts). In pancreas divisum, the ventral duct drains into the major papilla, while the dorsal duct drains into a separate minor papilla. The majority of individuals born with pancreas divisum experience no symptoms throughout life, will remain undiagnosed and will not require treatment. A small number of patients with pancreas divisum will experience repeated episodes of pancreatitis.
Duodenal biliary drainage is a little-used procedure
that sometimes can be helpful in diagnosing gallstones.
How is duodenal biliary drainage done?
For duodenal biliary drainage, a
thin plastic or rubber tube with several holes at its tip is passed through a patient's anesthetized nostril,
down the back of the throat, through the esophagus and stomach, and into the duodenum where the bile and pancreatic ducts enter the
small intestine. This is
accomplished with the help of fluoroscopy,
a type of X-ray. Once the tube is in
place, a synthetic hormone related to cholecystokinin is injected intravenously.
The hormone causes the gallbladder to contract and squeeze out its concentrated
bile into the duodenum. The bile then is sucked up through the tube and examined
for the presence of cholesterol and pigment particles under a microscope.
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