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Endoscopic Retrograde Cholangiopancreatography (ERCP)

  • What is endoscopic retrograde cholangiopancreatography (ERCP)?

    ERCP
    Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure used to visualise and treat diseases of the bile and pancreatic ducts.

    The endoscope is inserted through the mouth and carefully pushed down into the stomach and into the first part of the small intestine (the duodenum). It is then used to find the opening (papilla) of a bile duct that empties into the duodenum. A small plastic tube is passed down the endoscope through the papilla to reach the bile and pancreatic ducts. A small amount of dye is then injected into the ducts to allow x-ray images to be captured.

    What are bile and pancreatic ducts?

    Bile ducts are tubes that carry bile from the liver to the gallbladder and duodenum. These bile ducts merge into a common bile duct. Pancreatic ducts are tubes that transport pancreatic juice from the pancreas to the duodenum. Small pancreatic ducts empty into the main pancreatic duct.

  • Your doctor may recommend an ERCP to assess and treat conditions and symptoms such as:

    • Jaundice (yellow skin or eyes), light stool, and dark urine
    • Upper abdominal pain
    • Gallstones that become stuck in the common bile duct
    • Infection in the bile ducts
    • A lesion, tumour or cancer in the pancreas, gallbladder or liver
    • Acute and chronic pancreatitis

    ERCP is primarily used to treat problems of the bile and pancreatic ducts. It is also used before and after gallbladder surgery to improve the surgical procedure.

  • Preparing for the procedure

    Before going in for an ERCP procedure, inform your doctor about any allergies or medical conditions that you have as well as all prescribed and over-the-counter medicines, vitamins, and supplements you take. You may be asked to temporarily stop taking certain medicines such as those that affect blood clotting or interact with sedatives. If you are or may be pregnant, tell your doctor so that the necessary changes to the procedure may be done to protect your baby.

    Driving is discouraged within 24 hours of an ERCP procedure as the sedatives and anaesthesia administered during the procedure take time to wear off. Make plans to have someone take you home after the procedure.

    You are advised to not eat or drink for 8 hours prior to the procedure so that a clear view of your upper gastrointestinal tract can be obtained.

    During the procedure

    The ERCP typically takes between 1 and 2 hours. Patients undergoing the procedure will have sedatives administered to them via an intravenous needle in their arm to help them stay comfortable during the procedure. A liquid anaesthetic will also be given to be gargled. The anaesthetic functions to numb the throat and helps prevent gagging during the procedure.

    The procedure is done with the patient lying on their left side or their belly on the examination table. An endoscope is carefully entered through the mouth, down the oesophagus and stomach, into the duodenum. The endoscope pumps air into the stomach and duodenum for a clear view obtained via the camera that is mounted on the scope. With the endoscope in the duodenum, the doctor performs the following:

    • Locates the opening where the bile and pancreatic ducts empty into the duodenum
    • Slides a thin, flexible tube called a catheter through the endoscope and into the ducts
    • Injects a special dye into the ducts through the catheter to make the ducts more visible on x-rays
    • Uses a type of x-ray imaging called fluoroscopy to examine the ducts and look for narrowed areas or blockages

    As the ERCP procedure is usually performed for therapeutic purposes, the doctor may pass tiny tools through the endoscope to achieve the following:

    • Open blocked or narrowed ducts
    • Break up or remove stones
    • Perform a biopsy (removal of a small amount of tissues) or remove tumours in the ducts
    • Insert stents (tiny tubes to open narrowed ducts)

    After the procedure

    After the procedure is completed, you can expect to rest at the hospital for 1 to 2 hours for the sedation and anaesthesia to wear off, after which you will be able to return home and rest for the remainder of the day. In some cases, patients may be required to stay overnight in the hospital. Patients may experience bloating or nausea for a short time and a sore throat for 1 to 2 days after the procedure.

    Risks associated with ERCP

    ERCP is a safe procedure. However, a small fraction of patients may experience complications, such as the following:

    • Pancreatitis
    • Infection of the bile ducts or gallbladder
    • Excessive bleeding
    • An abnormal reaction to the sedative
    • Tear in the bile or pancreatic ducts, or near the duodenum opening
    • Tissue damage from x-ray exposure
  • The newly refurbished endoscopy centre at Gleneagles Hospital provides a range of diagnostic and therapeutic endoscopic procedures.

    These include ERCP, colonoscopy, gastroscopy, bronchoscopy and cystoscopy, as well as endoscopic submucosal dissection and insertion of percutaneous endoscopic gastrostomy.

    Your goal of getting the most appropriate treatment is our strength. Quality and customised healthcare has been our legacy for more than 60 years.

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