The liver, bile ducts, gallbladder, pancreas and the papilla of Vater
can be involved in numerous diseases, causing myriad of symptoms. ERCP is
used in diagnosing and treating the following conditions:
Gallstones in the bile duct
Blockage of the bile duct by stones, cancer,
stricture or compression from adjacent organs
Jaundice (yellow coloring of the skin) due to
obstruction of the bile duct, also causing darkening of the urine and light
colored stool.
Persistent or recurrent upper abdominal pain which
cannot be diagnosed by other tests
Unexplained loss of appetite and weight loss
Confirming the diagnosis of cancer of the pancreas or the bile duct,
so that surgery or other treatment can be tailored
ERCP is a highly specialized procedure which requires a lot of
experience and skill. The procedure is quite safe and is associated with a
very low risk when it is performed by experienced physicians. The success
rate in performing this procedure varies from 70% to 95% depending on the
experience of the physician. Complications can occur in approximately one
to five percent depending on the skill of the physician and the underlying
disorder. The most common complication is pancreatitis which is due to
irritation of the pancreas and can occur even in very experienced
physicians. This " injection " pancreatitis is usually treated
in the hospital for one to two days. Another possible complication is
infection. Other serious risks including perforation of the bowel, drug
reactions, bleeding, depressed breathing, irregular heart beat or heart
attack are extremely rare. In case of complication, patient needs to be
hospitalized and surgery is rarely required.
In summary, ERCP is a rather simple outpatient examination that is performed
with the patient sedated. The procedure provides significant information
upon which specific treatment can be tailored. In certain cases,
therapy can be performed at the same time through the duodenoscope, so
that traditional open surgeries can be avoided. ERCP is currently the
diagnostic and therapeutic procedure of choice in most patients for
identifying and removing gallstones in the bile ducts.
Endoscopic Retrograde Cholangio-Pancreatography at a Glance
ERCP is a diagnostic procedure to examine diseases of
the liver, bile ducts and pancreas.
ERCP is performed under intravenous sedation, usually
without general anesthesia.
ERCP is an uncomfortable but not painful procedure.
There is a low incidence of complications.
ERCP can provide important information that cannot be
obtained by other diagnostic examinations, e.g. abdominal ultrasound, CT scan,
endoscopic ultrasonography (EUS), or MRI.
Frequently, therapeutic measures can be performed at the time of ERCP
to remove stones in the bile ducts or to relieve obstructions of the
bile ducts.
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.
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