Endoscopic Retrograde Cholang... Health Article

Definition

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique in which a hollow tube called an endoscope is passed through the mouth and stomach to the duodenum (the first part of the small intestine). This procedure was developed to examine abnormalities of the bile ducts, pancreas, and gallbladder. It was developed during the late 1960s and is used today to diagnose and treat blockages of the bile and pancreatic ducts.

The term has three parts to its definition:

• "Endoscopic" refers to the use of an endoscope.
• "Retrograde" refers to the injection of dye up into the bile ducts in a direction opposing, or against, the normal flow of bile down the ducts.
• Cholangiopancreatography means visualization of the bile ducts (cholangio) and pancreas (pancreato).

Purpose

Until the 1970s, methods to visualize the bile ducts produced images that were of relatively poor quality and often misleading; in addition, the pancreatic duct could not be examined at all. Patients with symptoms related to the bile ducts or pancreatic ducts frequently needed surgery to diagnose and treat their conditions.

Using ERCP, physicians can obtain high-quality x rays of these structures and identify areas of narrowing (strictures), cancers, and gallstones. This procedure can help determine whether bile or pancreatic ducts are blocked; it also identifies where they are blocked along with the cause of the blockage. ERCP may then be used to relieve the blockage. For patients requiring surgery or additional procedures for treatment, ERCP outlines the anatomical changes for the surgeon.

Precautions

The most important precaution is that the examination should be performed by an experienced physician. The procedure is much more technically difficult than many other gastrointestinal endoscopic studies. Patients should seek physicians with experience performing ERCP. Patients should inform the physician about any allergies (including allergies to contrast dyes, iodine, or shellfish), medication use, and medical problems. Occasionally, patients may need to be admitted to the hospital after the procedure.

Description

After sedation, a specially adapted endoscope is passed through the mouth, through the stomach, then into the duodenum. The opening to ducts that empty from the liver and pancreas is identified, and a plastic tube or catheter is placed into the orifice (opening). Contrast dye is then injected into the ducts, and with the assistance of a radiologist, pictures are taken.