ERCP
(Endoscopic Retrograde
Cholangio-Pancreatography)
What is ERCP?
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.
Next: What kind of preparation is required? »
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