Endoscopic retrograde cholangiopancreatography (ERCP)
enables the physician to diagnose problems in the liver,
gallbladder, bile ducts, and pancreas. The liver is a large organ
that, among other things, makes a liquid called bile that helps
with digestion. The gallbladder is a small, pear-shaped organ that
stores bile until it is needed for digestion. The bile ducts are
tubes that carry bile from the liver to the gallbladder and small
intestine. These ducts are sometimes called the biliary tree. The
pancreas is a large gland that produces chemicals that help with
digestion and hormones such as insulin.
ERCP is used primarily to diagnose and treat
conditions of the bile ducts, including gallstones, inflammatory
strictures (scars), leaks (from trauma and surgery), and cancer.
ERCP combines the use of x rays and an endoscope, which is a long,
flexible, lighted tube. Through the endoscope, the physician can
see the inside of the stomach and duodenum, and inject dyes into
the ducts in the biliary tree and pancreas so they can be seen on
x rays.
For the procedure, you will lie on your left
side on an examining table in an x-ray room. You will be given
medication to help numb the back of your throat and a sedative to
help you relax during the exam. You will swallow the endoscope,
and the physician will then guide the scope through your
esophagus, stomach, and duodenum until it reaches the spot where
the ducts of the biliary tree and pancreas open into the duodenum.
At this time, you will be turned to lie flat on your stomach, and
the physician will pass a small plastic tube through the scope.
Through the tube, the physician will inject a dye into the ducts
to make them show up clearly on x rays. X rays are taken as soon
as the dye is injected.
If the exam shows a gallstone or narrowing of
the ducts, the physician can insert instruments into the scope to
remove or relieve the obstruction. Also, tissue samples (biopsy)
can be taken for further testing.
Possible complications of ERCP include
pancreatitis (inflammation of the pancreas), infection, bleeding,
and perforation of the duodenum. Except for pancreatitis, such
problems are uncommon. You may have tenderness or a lump where the
sedative was injected, but that should go away in a few days.
ERCP takes 30 minutes to 2 hours. You may have
some discomfort when the physician blows air into the duodenum and
injects the dye into the ducts. However, the pain medicine and
sedative should keep you from feeling too much discomfort. After
the procedure, you will need to stay at the hospital for 1 to 2
hours until the sedative wears off. The physician will make sure
you do not have signs of complications before you leave. If any
kind of treatment is done during ERCP, such as removing a
gallstone, you may need to stay in the hospital overnight.
Preparation
Your stomach and duodenum must be empty for the
procedure to be accurate and safe. You will not be able to eat or
drink anything after midnight the night before the procedure, or
for 6 to 8 hours beforehand, depending on the time of your
procedure. Also, the physician will need to know whether you have
any allergies, especially to iodine, which is in the dye. You must
also arrange for someone to take you home—you will not be allowed
to drive because of the sedatives. The physician may give you
other special instructions.
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