ERCP – endoscopic retrograde cholangio-pancreatography

Endoscopic retrograde cholangio-pancreatography is a combination of an endoscopic procedure and a radiological (x-ray) procedure aimed at imaging bile ducts and the pancreatic duct with prior contrast administration.

INDICATIONS / WHY IS IT PERFORMED?

• For diagnostic purposes, to determine the cause of impaired bile flow when stones are present in the bile and pancreatic ducts, bile duct tumors, pancreatic and liver tumors.
• For therapeutic purposes for gallstones in the bile ducts, when the therapeutic procedure is continued during ERCP – a papilotomy during which the duodenal papilla of Vater is intersected and then the stuck gallbladder is removed.

HOW IS IT PERFORMED?

The procedure is performed under general anesthesia.
The pancreatic duct and bile ducts enter together through the papilla into the duodenum. At this point of entrance, a flexible optical instrument (endoscope) is introduced by which the gastroenterologist has previously passed through the mouth, esophagus, stomach, all the way to the duodenum.
In order to be X-rayed, a contrast medium is injected into the pancreatic duct and bile ducts.

If during the examination a specific obstacle is found, the papilla is opened with the help of an electrically operated cutting instrument (papillot) introduced through the endoscope. This makes it possible to e.g. remove stones from the duct and allow the drainage of bile and pancreatic flow.

If larger stones cannot be removed by opening the papilla, these can be mechanically crushed (reduced).

POTENTIAL RISKS

Injection of contrast medium into the bile and pancreatic duct as well as the opening of the papilla can in some cases cause acute inflammation, which most often quickly withdraws.

In rare cases there are:

• hypersensitivity reactions to drugs or anesthetics given during ERCP or to the contrast agent.
• haemorrhage or organ damage (e.g. intestinal incision).
• stones in ducts which cannot be removed can be stuck in the papilla area. This can cause pain (colic) and completely prevent flow of the contents from the bile ducts and pancreas with fever, shivering, elevated temperature, jaundice, including general infection (sepsis).
• blood compensation and/or abdominal surgery (laparotomy) may be necessary after bleeding.
• stuck stones and bowel injuries may be the reason for immediate surgical intervention

PREPARATION

Six hours before the examination, no food or liquids should be taken.

AFTER ASCITES PUNCTURE

A hospital stay of at least 24 hours after the intervention, during which the patient’s condition is monitored and the laboratory analyses are performed, is advised.