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ERCP

Endoscopic retrograde cholangiopancreatography (en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee) (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.

ERCP may be used to discover the reason for jaundice, upper abdominal pain, and unexplained weight loss. ERCP combines the use of x-rays and an endoscope, which is a long, flexible, lighted tube. Through it, the physician can see the inside of the stomach, duodenum, and ducts in the biliary tree and pancreas.

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 duringDigestive System 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. A radiographer will begin taking x-rays 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 work around the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Unfortunately, while ERCP represents a truly remarkable way to evaluate and treat problems in the biliary system, problems and complications tend to be more frequent and severe than in other endoscopic procedures.  The most common complication of ERCP is pancreatitis.  The area that is injected with X-ray contrast during ERCP is right near the pancreas, a very sensitive organ.  ERCP-related pancreatitis can range from mild inflammation of the duct from the X-ray dye (chemical pancreatitis) to much more severe disease.  Severe post-ERCP pancreatitis, occurring less than a few percent of the time, can lead to breathing problems, extra fluid in the lungs or abdominal cavity, formation of cysts that need to be drained surgically, hemorrhage, or, in exceedingly rare circumstances, death.  Also, bleeding in the duodenum, perforation of the bowels, and infection are also possible. You may have tenderness or a lump where the sedative was injected, but that should go away in a few days or weeks.

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 or outpatient center for several 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.

Your physician will give you instructions to prepare for ERCP.  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.