Ask the experts
My mother recently had ERCP to diagnose flare ups of pancreatitis. The doctor had to remove the scope and attach a smaller "flushing probe," and finally had to stop altogether. She said the opening was tiny and rather "hard." Is this common? My mom was in the hospital with a second flare up.
Doctor's response
ERCP (endoscopic retrograde cholangio-pancreatography) is a procedure for obtaining X-rays of the bile and pancreatic ducts which carry the fluids produced by the liver and pancreas into the intestine. During ERCP, an endoscope (a fiber-optic containing, flexible, hose-like instrument) is swallowed and passed through the stomach and into the first part of the small intestine, the duodenum, where the bile and pancreatic ducts enter the intestine. A thin catheter is advanced through a channel in the endoscope and inserted into the opening of the bile and/or pancreatic ducts. X-ray dye is then injected into the ducts, and X-rays of the filled ducts are taken. The X-rays can demonstrate narrow and dilated areas of the ducts or gallstone(s) in the ducts which may be causing problems, for example, pancreatitis.
Sometimes the openings of the ducts into the intestine are very small, either naturally or because they have been narrowed by inflammation and scarring. In such cases it may be difficult or impossible to pass the catheter into the duct in order to inject the X-ray dye. It sounds like this may have been the problem encountered with your mother. Although ERCP probably is the best way of examining the pancreatic duct, other methods include computerized tomography (CT), magnetic resonance imaging(MRI) and endoscopic ultrasonography.
Jay W. Marks, M.D.