Endoscopic retrograde cholangiopancreatography, or ERCP, is a procedure that combines upper gastrointestinal, or GI, endoscopy and x-rays to evaluate and treat problems of bile and pancreatic ducts. Dr. Patel, can you tell us more about ERCP?
Absolutely, Major Spencer. ERCP may be used to diagnose bile and pancreatic duct conditions, but also allows for simultaneous intervention or treatment when problems are found. For diagnosis alone, providers may use noninvasive tests, such as magnetic resonance cholangiopancreatography, or MRCP, instead.
Providers typically use ERCP when the bile or pancreatic ducts have become narrowed or blocked. Conditions that can cause the bile and pancreatic ducts to become blocked include:
- Gallstones that travel from the gallbladder into the common bile duct
- Acute and chronic pancreatitis
- Trauma or surgical complications
- Pancreatic stones
- Endoluminal stent failure after prior ERCP placement of a stent, and
- Tumors, cysts, or cancers of the bile ducts, pancreas, duodenum, or ampulla of Vater
During ERCP, the provider passes a thin, flexible tube called an endoscope through the mouth into the esophagus, stomach, and the first part of the small intestine, called the duodenum. The endoscope has a tiny camera at the end so that the provider can see the inner lining of the upper GI tract. The endoscope pumps air into the stomach and duodenum to make them easier to see.
During the procedure, the provider locates the opening where the bile and pancreatic ducts empty into the duodenum. Next, the provider slides a catheter through the endoscope and into the ducts. A special dye, called contrast medium, is injected into the ducts through the catheter to make the ducts more visible on x-rays. The provider then uses a type of x-ray imaging, called fluoroscopy, to examine the ducts and look for narrowed areas or blockages.
Tiny tools may be passed through the endoscope to open blocked or narrowed ducts, break up or remove stones, take tissue samples, remove tumors, or insert stents to hold narrowed ducts open.
ERCP is done while the patient is under an intravenous sedative or general anesthesia. A gargle or spray to numb the throat may also be given to prevent stimulation of the natural gag reflex during the procedure. Some people may experience a sore throat for a day or two after their ERCP.