Procedures

E.R.C.P.
Endoscopic Retrograde Cholangio-Pancreatography
A Guide to the Test

WHAT IS AN E.R.C.P.?

ERCP stands for Endoscopic Retrograde Cholangio-Pancreatography. As hard as it is to say, the actual examination is fairly simple.

A dye is injected into the bile and pancreatic ducts using a flexible video endoscope. X-rays are then taken to outline the bile ducts and the pancreas.

The liver produces bile, which flows through the ducts and passes or fills the gallbladder and then enters the intestine (duodenum) just beyond the stomach. The pancreas (which is 6-8 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.

EQUIPMENT USED

The video 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 fibreoptic 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 solution.

REASONS FOR EXAMINATION

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

ERCP helps in diagnosing and often treating these conditions:

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

WHAT PREPARATION IS REQUIRED?

The only preparation needed before an ERCP is not to eat or drink for eight (8) hours prior to the procedure.

WHAT CAN BE EXPECTED DURING ERCP?

Your doctor will discuss why an ERCP is being performed, potential complications from ERCP and alternative diagnostic or therapeutic tests that are available. A local anaesthetic will be sprayed to your throat and an intravenous anaesthetic/sedative will be given to make you more comfortable during the test. Most patients also receive antibiotics before the procedure.

The test begins with you lying on your left side on an x-ray table. The endoscope is passed through the mouth, oesophagus and stomach into the duodenum. The instrument does not interfere with your breathing. Some air is introduced and may cause temporary bloating during and after the procedure. The injection of contrast dye into the ducts rarely causes discomfort.

WHAT ARE THE POSSIBLE COMPLICATIONS OF ERCP?

ERCP is generally a well-tolerated procedure when performed by specialists who have had training and experience in this technique.

Major complications requiring hospitalisation can occur but are uncommon during diagnostic ERCP. They include serious pancreatitis, infections, bowel perforation, and bleeding, with each occurring in less than 1% of patients. Another potential risk of ERCP is an adverse reaction to the anaesthetic/sedative used. The risks of the procedure vary with the indications for the test, what is found during the procedure, what therapeutic intervention is undertaken, and the presence of other major medical problems, eg. heart or lung disease. Your specialist will tell you what your likelihood of complications is before undergoing the test.

If therapeutic ERCP is performed (cutting and opening in the bile duct – “sphincterotomy”, stone removal, dilation of a stricture, stent or drain placement, etc.), the possibility of a complication is somewhat higher:

• Pancreatitis in 3-5%
• Bleeding requiring transfusion in 2-3%
• Bowel perforation in 1-2%

These risks must be balanced against the benefits of the procedure and the risks of alternative surgical treatment of the condition. Often these complications can be managed without surgery but occasionally surgery is necessary.

RESULTS

After the examination, the specialist explains the results. If the effects of the anaesthetic are prolonged, the specialist may suggest an appointment for a later date when the patient can fully understand the results.

WHAT CAN BE EXPECTED FOLLOWING ERCP?

If you are having an ERCP as an outpatient, you will be kept under observation until most of the effects of the medications have worn off. Evidence of any complications of the procedure will be looked for and hospitalisation may be advised if further observation is necessary. You may experience bloating or pass gas because of the air introduced during the examination. You may resume your usual diet, unless you are instructed otherwise.

You will need to arrange to have someone accompany you home from the examination.

Do not:

• Drive a car
• Work machinery
• Consume alcohol
• Sign legal documents
• Make important decisions

Until the following day.

If any of your questions have not been answered here, please feel free to discuss them with the endoscopy nurse or your doctor before the procedure begins.