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Endoscopic Retrograde Cholangio-Pancreatography is used worldwide for inspecting the pancreas and bile ducts. Bile diseases can not only be detected, but also treated using this procedure. This article highlights indications and complications of ERCP.

Endoscopic Retrograde Cholangio-pancreatography, or ERCP, is a diagnostic test that makes use of X-rays and an endoscope to inspect the bile and pancreatic ducts. ERCP is also used to remove gallstones, or for taking samples for biopsy.    

What Is ERCP?

Endoscopic retrograde cholangio-pancreatography is a medical procedure that is used to examine structures related to the pancreas and the gallbladder.

These structures include:

  • Duodenum – first part of the small intestine
  • Bile duct
  • Gallbladder
  • Pancreatic duct
  • Papilla of Vater– a nipple-like structure that opens into the bile and pancreatic ducts

ERCP uses an endoscope (thin, flexible tube). It has a camera and fiber-optic channels at one end, and is connected to an output video feed at the other end. The tube is inserted through the mouth of the patient, and passes into the esophagus, on to the stomach and into the upper part of the digestive tract (duodenum).

In this procedure, the term ‘cholangio-pancreatography’ describes the X-rays that are taken of the bile and pancreatic duct. In order to view the ducts more clearly, a dye is sometimes injected into the ducts so that they show up more clearly in the pictures. In ERCP, a ‘retrograde’ injection of the dye is given, which means that it is injected through the papilla back up into the ducts. This retrograde injection is given through a plastic tube at the side of the endoscope.  

When Is ERCP done? Indications

ERCP is a modern and useful procedure that is used worldwide. It is used for both the diagnosis, and the treatment, of various conditions relating to the digestive tract. Cholangitis (infected bile duct) is the disorder where ERCP is the test of choice. Besides that, there are numerous conditions where ERCP is indicated. Listed below are some of the common indications of ERCP.

  • Gallstones – in the gallbladder or bile ducts.
  • Acute and chronic pancreatitis – short-term or long-term inflammation of the pancreas, respectively.
  • Recurring abdominal pain.
  • Jaundice
  • Diseases of the bile ducts.
  • Open a narrowed bile or pancreatic duct.
  • Manometry – measuring the pressure inside the bile ducts.
  • Sclerosis - scarring of the ducts.
  • Pseudocysts – accumulation of fluids and tissue debris.
  • Biopsy – obtaining a tissue sample from the ducts.

Preparations Before ERCP

Endoscopic Retrograde Cholangio-pancreatography in an invasive procedure. It is important to make the required preparations before commencing the procedure. The aim of these preparations is to prevent any complications during the procedure. Certain instructions given before the procedure are:

  • Do not eat anything for at least 6-8 hours before the procedure. Drinking small amounts of water after short intervals may be allowed for at least 2 hours before an ERCP. Smoking and chewing gum is also prohibited.
  • Certain medications that you may be taking will be temporarily discontinued before the procedure. These include anti-coagulants or any medicines that may interact adversely with the anesthetic.
  • Allergies to any medications or anesthesia that may be given during the procedure should be told to the doctor before starting the ERCP.
  • The doctor should be aware of any health problems the patient may have, such as heart and lung diseases and diabetes.
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