ERCP is a combination of X-ray and a long, flexible, lighted tube
ERCP is a combination of X-ray and a long, flexible, lighted tube

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It is a combination of X-ray and a long, flexible, lighted tube (endoscope). Doctors usually guide the endoscope through the mouth and throat and then down to the stomach and the first part of the small intestine (duodenum). Next, they will pass a tube through the scope and inject a dye. This highlights the organs on the X-ray. This procedure helps doctors to view these organs in detail and check for problems. 

Why is an ERCP done?

An individual may need endoscopic retrograde cholangiopancreatography (ERCP) to determine the cause of unexplained and recurrent abdominal pain or yellowing of the skin and eyes (jaundice). It also helps in the diagnosis of the following conditions:

  • Pancreatitis (inflammation of the pancreas)
  • Cancer of the liver, pancreas, or bile ducts
  • Blockages or stones in the bile ducts
  • Fluid leakage from the bile or pancreatic ducts
  • Blockages or narrowing of the pancreatic ducts
  • Infection in the bile ducts
  • Severe injury or surgical complications in the bile or pancreatic ducts

What happens during an ERCP procedure?

Endoscopic retrograde cholangiopancreatography (ERCP) may be done on an outpatient basis or as part of hospital stay. Procedures may vary based on patient’s condition.

Generally, during an ERCP procedure:

  • An intravenous (IV) line will be put in on the patient’s arm or hand for anesthesia.
  • Most endoscopy units use a combination of a sedative to induce relaxation and medication to prevent discomfort. This is called “conscious sedation” because the patient is awake, but the body is relaxed and pain is numbed. In some more complicated cases, the patient may be sedated more heavily or given anesthesia (put to sleep) for the ERCP procedure.
  • The patient may get oxygen through a tube in their nose during the procedure.
  • They will be positioned on their left side or, more often, on their belly on the X-ray table.
  • A numbing medicine may be sprayed into the back of their throat. This prevents gagging as the endoscope is passed down the throat. The patient will not be able to swallow the saliva that is collected in the mouth during the procedure. It will be suctioned from the mouth as needed.
  • A mouth guard will be put in their mouth to keep them from biting down on the endoscope and to protect their teeth.
  • Once the throat is numbed and patient is relaxed from the sedative, the doctor will guide the endoscope down the patient’s digestive duodenum until it reaches the ducts of the biliary tree (throat into their stomach).
  • A small tube will be passed through the endoscope to the stomach, and a contrast dye will be injected into the ducts. Air may be injected before the contrast dye. This may cause the patient to feel fullness in the abdomen.
  • Various X-ray views will be taken. The patient may be asked to change positions during this time.
  • After X-rays of the biliary tree are taken, the small tube for dye injection will be repositioned to the pancreatic duct. The contrast dye will be injected into the pancreatic duct, and X-rays will be taken. Again, the patient may be asked to change positions while the X-rays are taken.
  • If needed, the doctor may take samples of the fluid or tissue. Sometimes, other procedures such as the removal of gallstones or other blockages are done, while the endoscope is in place.
  • After the X-rays and any other procedures are done, the endoscope will be withdrawn.
  • The length of the examination varies between 30 and 90 minutes (usually about an hour).

What are the side effects of ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is a safe procedure. Side effects can occur with any medical procedure. Below are a few common side effects of ERCP:

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Medically Reviewed on 8/18/2020
References
Endoscopic Retrograde Cholangiopancreatography (ERCP): (https://emedicine.medscape.com/article/1829797-overview)