During an ERCP, dye is injected into the bile and pancreatic ducts using a flexible, fiberoptic endoscope. Then x-rays are taken to outline the bile ducts and pancreas. The liver produces bile, which flows through the ducts, passes or fills the gallbladder and enters the intestine (duodenum) just beyond the stomach. The pancreas which is six to eight inches long, sits behind the stomach. This organ secretes digestive enzymes that flow into the intestine through the same opening as the bile. Both bile and enzymes are needed to digest food.

REASONS FOR THE EXAM

Due to factors related to diet, environment and heredity, the bile ducts, gallbladder and pancreas are the seat of numerous disorders. These can develop into a variety of diseases and/or symptoms.

ERCP helps in diagnosing and often in treating the condition. ERCP is used for:

  • Gallstones, which are trapped in the main bile duct
  • Blockage of the bile duct
  • Yellow jaundice, which turns the skin yellow and the urine dark
  • Undiagnosed upper abdominal pain
  • Cancer of the bile ducts or pancreas
  • Pancreatitis (inflammation of the pancreas)

PREPARATION

Do not eat or drink anything after midnight on the day prior to your procedure. Important medications such as insulin or heart pills, should be taken. Medications such as Coumadin, aspirin and arthritis medicines should be stopped at least five days prior to the procedure.

EQUIPMENT

The flexible endoscope is a remarkable piece of equipment that can be directed and moved around the many bends in the upper gastrointestinal tract. A thin, glass fiberoptic bundle collects light at one tip of the scope and, regardless of how it is angled, transmits the image to the other viewing end. An open channel in the scope allows other instruments to be passed through it to perform biopsies, remove polyps or inject solutions.

RISKS

Certain risks which can be life threatening are associated with this procedure. These risks include perforation of the bowel or bile ducts, bleeding, bile duct infection, pancreatitis and drug reactions. Perforation (puncture of the bowel or bile ducts) is rare, but would require immediate hospitalization, antibiotics and perhaps surgery. Bleeding that is severe enough to require a blood transfusion is rare and is usually restricted to those persons undergoing a sphincterotomy. Bile duct infection and pancreatitis (inflammation of the pancreas) would require medical treatment in the hospital for a number of days. Adverse reactions to medications given intravenously at the onset of the procedure include inflammation at the site of injection and slowing of your breathing rate which might aggravate a pre-existing lung problem such as emphysema.

PROCEDURE

An ERCP uses x-ray films and is performed in an x-ray room. The throat is anesthetized with a spray or solution, and the patient is usually mildly sedated. The endoscope is then gently inserted into the upper esophagus. The patient breathes easily through the exam, with gagging rarely occurring. A thin tube is inserted through the endoscope to the main bile duct entering the duodenum. Dye is then injected into this bile duct and/or pancreatic duct and x-ray films are taken. The patient lies on his or her left side and then turns onto the stomach to allow complete visualization of the ducts. If a gallstone is found, steps may be taken to remove it. If the duct has become narrowed, an incision can be made using electrocautery (electrical heat) to relieve the blockage. Additionally it is possible to widen narrowed ducts and to place small tubing in these areas to keep them open. The exam takes from 20 to 40 minutes.

RESULTS

After the exam, the physician explains the results to the patient and family. An ERCP is performed primarily to identify and/or correct a problem in the bile ducts or pancreas. This means the test enables a diagnosis to be made upon which specific treatment can be given. If a gallstone is found during the exam, it can often be removed, eliminating the need for major surgery. If a blockage in the bile duct causes yellow jaundice or pain, it can be relieved.