Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique used for the diagnosis and treatment of problems in the liver, gallbladder, bile ducts, and pancreas. It is of particular use in diagnosing and treating problems such as gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP is an x-ray examination of the bile ducts which is aided by a video endoscope. With the endoscope physicians see inside the stomach; dyes which are injected in to the ducts of the biliary tree and pancreas can be seen on x-rays.

In order for the procedure to be effective, the patient%u2019s stomach has to be empty, so the patient has to refrain from eating 6-8 hours before the procedure. The patient is sedated, and then a flexible camera is inserted through the mouth, down the esophagus, into the stomach, through the opening of the common bile duct and pancreatic duct exists. Fluoroscopy is used to look for blockages, or leakage of bile into the abdominal cavity.

When used for the treatment of gallstones there are some modifications to the procedure. A wire and balloon may be passed into the bile duct, and then inflated to expand the opening of the bile duct to allow passage of gallstones. When needed, the opening of the ampulla can be enlarged with an electrified wire, and access into the bile duct obtained so that gallstones may be removed or other therapy performed.

The main risk associated with ERCP is developing pancreatitis, which can occur in up to 5% of all procedures. Most often the symptoms are mild, but in some cases may require hospitalization, and rarely may be life-threatening. Patients at additional risk for pancreatitis are younger patients, patients with previous post-ERCP pancreatitis, and women.