ERCP

ERCP is performed at the hospital as this requires fluoroscopy. This procedure is used to examine the duodenum, bile ducts, gallbladder and pancreatic duct. The physician uses a small camera, called an endoscope, which is guided down the throat. The procedure usually lasts from 30 minutes to an hour.

How is the procedure performed

The flexible endoscope is a remarkable piece of equipment that can be directed and moved around the many bends in the gastrointestinal tract. The video endoscopes have a tiny, optically sensitive computer chip at the end. Electronic signals are then transmitted up the scope to the computer which then displays the image on a large video screen. An open channel in these scopes allows other instruments to be passed through in order to take tissue samples, remove polyps and perform other exams.

Reasons for the Exam

Due to factors related to diet, environment and heredity, the upper GI tract is the site of numerous disorders. These can develop into a variety of diseases and/or symptoms. ERCP helps in diagnosing and often treating these conditions:

Biliary diseases– which can develop in the gall bladder and biliary ducts, such as gall stones, tumors, infectious, immune and inflammatory conditions. Therapeutic procedures involve removing stones, obtaining biopsies, placement of biliary stents, etc.

Pancreatic disease– causes abnormalities of the pancreas, pancreatic ducts, stones, tumors, infectious, immune and inflammatory conditions.

Preparation

It is important not to eat or drink anything for at least eight hours before the exam. The physician instructs the patient about the use of regular medications, including blood thinners, before the exam.

The Procedure

ERCP is usually performed on an outpatient basis, at the hospital. Intravenous sedation is usually given to relax the patient, eliminate the gag reflex and cause short-term amnesia. The endoscope is then gently inserted into the upper esophagus. The patient can breath easily throughout the exam. Other instruments can be passed through the endoscope to perform additional procedures if necessary. For example, a biopsy can be done in which a small tissue specimen is obtained for microscopic analysis. A polyp or tumor can be removed using a thin wire snare and electrocautery (electrical heat). The exam takes from 30 minutes to an hour, after which the patient is taken to the recovery area. There is usually no pain with the procedure and patients seldom remember much about it.

Results

After the exam, the physician will explain the results to the patient and family.If a biopsy has been performed or a polyp removed, the results are not available for three to seven days.

Benefits

An upper GI endoscopy is performed primarily to identify and/or correct a problem in the upper gastrointestinal tract. This means the test enables a diagnosis to be made upon which specific treatment can be given. If a bleeding site is identified, treatment can stop the bleeding, or if a polyp is found, it can be removed without a major operation. Other treatments can be given through the endoscope when necessary.

Alternative Testing

Alternative tests to upper GI endoscopy include a barium x-ray and ultrasound (sonogram) to study the organs in the upper abdomen. Study of the stools, blood and stomach juice can provide indirect information about a gastrointestinal condition. These exams, however, do not allow for a direct viewing of the esophagus, stomach and duodenum, removing of polyps or taking of biopsies.

Side Effects and Risks

A temporary, mild throat irritation sometimes occurs after the exam. While serious risks with ERCP are uncommon, there is a 5-25 % risk of developing pancreatitis, which is a condition that may result in abdominal pain, hospitalization, and rarely surgery. Another risk associated with pancreatitis is excessive bleeding. In extremely rare instances, a perforation, or tear, in the biliary system or small bowel or stomach wall can occur. These complications may require hospitalization and, rarely, surgery. Quite uncommonly, a diagnostic error or oversight may occur. Due to the sedation, the patient should not drive or operate machinery following the exam. For this reason, someone else should be available to drive the patient home.

Summary

ERCP is an outpatient exam performed at the hospital, It requires patient sedated. The procedure provides significant information upon which specific treatment can be given. In certain cases, therapy can be administered directly through the endoscope. Serious complications while uncommon, may occur from ERCP.