ERCP

ERCP


Endoscopic retrograde choliangiopancreatography

ERCP stands for Endoscopic retrograde choliangiopancreatography.

It is procedure which allows the doctor to visualise, take a detailed x-ray of the liver ducts, duodenum, gall bladder, bile and pancreatic ducts as well as, where necessary, surgically treat any abnormality along these structures if possible, as well as take specimen for further laboratory test.

It is basically a cameral test. The endoscope is a long flexible tube, about the size of a pen. At its end is a cameral and good light source. It may have attached to it a videoscope or fibreoptic light system that transmits images to a screen. This is combined with the use of X – ray and dye.

After giving a sedative, the doctor introduces the endoscope through the mouth down to the upper small intestine (Duodenum).

He literally looks through the tube, see if he can identify any problem down the ducts. He then injects a contrast dye down the tube (endoscope).

An x – ray is taken. If the x –ray show any stone, the duct where the stone is found is enlarged and the tone crushed and removed. If the procedure is done for a pancreatic problem, say pancreatic stone or cancer, the obstructing specimen is removed and the duct clears again.

Any injury or bled is arrested by means of an electrical heating called diathermy which both cuts and seals tissue, depending on what the doctor wants. Any stone or tissue caught is removed by means a basket.

Sometimes there may be a need to leave a small narrow tube in the duct to bypass a stricture (called endoprothesis), especially in chronic Pancreatitis and obstructing pancreatic tumour.

PREPARING FOR THE TEST

The procedure normally takes any where between half an hour to two hours. Preparation for the test takes place once you are informed.

You should ideally have nothing to eat or drink in the 8 hours preceding the test. You can still take all your regular medications as before, but with very small amount of water. This is to prevent water gushing back to your throat during the test which can easily get into your airways as you will be too drowsy to be able to swallow or protect your airways.

Once you arrive in the hospital, you will need to sign a consent form if you have not done that already.

If you use any dentures, contact lens, or any metal objects on you, it is wise to inform the doctor, and remove them. During the examination, you will be lying on your left hand side, with your mouth opened. Once the injection is given to you through the vein, you will feel sleepy. Air would be blown into the duodenum and then dye later.

Once the test is completed, you will be moved to the recovery room. Once you get over the sedation, usually in about 1 – 2 hours, you should be ready to go home, if you had the test as an out patient without many complications.

During the waiting period, your blood pressure would be continuously monitored as well as your other parameter.

COMPLICATIONS

There is no procedure or operation without a complication.

ERCP is a relatively safe procedure. About 99 % of patients go home without any complication. Overall complication rate is under 5%. The common complications include:

BLEEDING

If the ducts are too small and a cut is made in them, bleeding occurs. It may be following division of the sphincter. Diathermy is often able to control this. Very very rarely, if bleeding persists, a transfusion or and an open operation may be needed.

INFECTION

Antibiotics are routinely given to all patients undergoing ERCP in many places. The risk of infection is very rare too. If it occurs, it is easily treated too.

PANCREATITIS

This is perhaps the more common complication following this procedure. It is due to irritation of the pancreas by the procedure. It resolves with treatment.

PERFORATION

While passing the tube down the gut, it very rarely penetrates through the wall to cause a hole in it. If this occurs, rest and antibiotics is all that is needed for the bowel to heal again.

Heart attack, rapid heart beat, damage of dentures and crowns, drug reactions are extremely rare but possible complications that have followed an ERCP.

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