ERCP

What is an ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive diagnostic and treatment procedure. ERCP combines the use of endoscopy and fluoroscopy to diagnose and treat problems of the pancreatic or biliary ductal systems.

What does an ERCP involve?

The procedure is performed in three main steps:

  1. You will be lying down on your left side, on the fluoroscope flatbed;
  2. You will be given intravenous sedation;
  3. An endoscope with a camera on one of its ends will be passed through your mouth and oesophagus to your duodenum. The doctor will be able to see the images projected by the camera on a screen. The endoscope will also inject a contrast medium which will allow for a fluoroscopy to be carried out as well.

What is ERCP used for?

You may need an ERCP if:

  • You have already done other tests such as an ultrasound or a CT scan and you have a confirmed diagnosis of bile duct stones or pancreatic cancer;
  • You have obstructive jaundice: when the flow of bile is obstructed and cannot reach the duodenum, a pigment known as bilirubin remains in the bloodstream, causing obstructive jaundice;
  • You have pancreatitis, which can be either acute or chronic. In the first case, the symptoms show up suddenly while in the second case the inflammation shows up progressively; pancreatitis becomes more severe, causing the destruction of the pancreas itself;
  • You have kidney stones or gallstones;
  • Benign or malignant pancreatic cancer, which could be caused by a proliferation of exocrine or endocrine cells within the pancreas;
  • You’re suffering from pancreas divisum, that is, an anomaly of the pancreas where the pancreatic duct is divided into two ducts instead of being a single duct;
  • You need to take a pancreatic tissue sample or bile duct cells sample for a biopsy. This is also extremely helpful when it comes to confirming a diagnosis of pancreatic cancer or cancer of the bile ducts.

This procedure can also be used as a treatment for:

  • Eliminating bile duct stones;
  • Doing a biliary stent, that is, putting a stent inside the bile duct to treat an obstruction or narrowing;
  • Treating a bile duct stricture;

How can I prepare for an ERCP?

Here is what you can do to prepare for an ERCP:

  • Talk to your GP in order to have your medical, clinical and family history sorted out in advance;
  • Do a blood test, an ECG and take your blood pressure;
  • If you are on certain medications, you may need to go off of those a few days before the procedure;
  • As a precautionary measure, you may need to get started on antibiotics;
  • Do not eat anything for at least eight hours before the procedure.

What does it feel like during an ERCP?

Should you be under local anaesthetics, it may feel like you can’t breathe when the endoscope is going down your oral cavity - rest assured though, the air flow won’t be blocked in any way.

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