Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
Endoscopy has helped to signficantly advance medical care within the last several decades, and endoscopic retrograde cholangiopancreatography
(ERCP) was one of the first such procedures to be applied to an important and major use. Essential to diagnosis and treatment
of biliary and pancreatic disease for more than 30 years now, ERCP is the most commmon procedure used in biliary endoscopy.
The procedure permits the physician to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas nonsurgically.
Patients fast prior to the procedure and receive a mild sedative. The specialist passes a special type of endoscope called
a duodenoscope down the throat. This lighted, flexible instrument is about the thickness of a pencil. The doctor advances
it into the stomach as well as into the duodenum (small intestine) and to the outlet of the bile ducts. The scope provides
clear views of the structures into which it is maneuvered.
The physician can inject dye (contrast material) into the ducts of the biliary system so that the area can be seen more clearly
on x-ray. This diagnostic procedure permits the medical team to to examine the duodenum, the common bile and pancreatic ducts
and the area where they enter the duodenum, and the gallbladder. For example, ERCP is used to locate gall stones and other
sources of abnormality in the bile ducts. This test can also identify inflammation or cancer in the pancreas. If abnormal
tissue is apparent or suspected, the specialist can also biopsy it with the duodenoscope, that is, remove a small amount of
fluid or tissue for evaluation under the microscope. This can help to determine the cause of the stricture or narrowing.
The resulting combination of detailed endscopic and x-ray images, gives ERCP the precision to also serve as a therapetuic
procedure today:
- Specialists can use the specially equipped scope to extract gallstones in the common and hepatic ducts. In the case of very
large stones, a specialized catheter may be used to crush or cut stones to free them.
- ERCP can be used for the step of sphincterotomy, in which the specialist uses an electric current transmitted through a catheter
to cut the muscle that surrounds the opening of bile duct or pancreas. This incision can permit the flow of bile fluid and
allow other procedures such as gallstone removal.
- If the bile duct has a blockage caused by a growth, scar, or stricture, specialists can use ERCP to reopen the bile drainage
through dilation or stenting. The prevents the inflammation that can result from bile fluid build up.
These steps can spare patients open surgical operations.
