What is ERCP?
ERCP is an advanced diagnostic endoscopic procedure used to examine the biliary tree (gallbladder, bile ducts, and pancreatic ducts). ERCP combines X-rays and endoscopy, allowing us to obtain high-quality images of the anatomy of the ducts.
This procedure is used to identify any obstruction or narrowing in the bile and pancreatic ducts or to perform biopsies of the same. In addition, it is the gold standard for the detection of stones (stones) in the common bile duct and is the procedure of choice to remove them.
How is an ERCP performed?
During the procedure, with the patient under general anesthesia, we will place a side-viewing endoscope (duodenoscope) in the duodenum in front of the greater papilla or outlet for bile into the small intestine. The duodenoscope is specially designed to facilitate the placement of endoscopic accessories within the bile and pancreatic ducts. A catheter is used to inject contrast medium into the bile and pancreatic ducts, and X-ray images are obtained using fluoroscopy.
When is ERCP indicated?
ERCP is indicated when it is suspected that the pancreatic and bile ducts may have narrowed or blocked due to
- – Tumors
- – Gallstones trapped in the ducts
- – Inflammation due to trauma or diseases such as pancreatitis
- – Narrowness or fibrosis of the bile ducts
- – Pseusocyst of pancreas
- – Close biliary fistulas
On other occasions, the presence of tumors, either in the ampulla of Vater or inside the bile ducts, requires the placement of biliary prostheses. Prosthetics are metal or plastic tubular attachments designed to restore the flow of the bile ducts, and are indicated to restore or maintain the passage of bile in areas with strictures or obstructions.
Tumor in the Ampula
Prosthesis placement
Installed Plastic Prosthesis
Another utility of ERCP is the drainage of Pancretic pseudocysts. Pseudocysts of the pancreas with fluid collections that can become infected and become true abscesses. These appear as a complication of acute pancreatitis. They are generally attached to the back wall of the stomach. Endoscopically (without the need for extensive surgeries), an incision is made in the wall of the stomach or small intestine to access the cavity of the pseudocyst. Subsequently, the incision is enlarged or dilated and several plastic biliary prostheses are placed that will remain in place until the complete resolution of the pseudocyst is achieved.
How is recovery from ERCP?
After ERCP, the patient is transferred to a recovery room where they remain for an hour or two until the effects of the anesthesia wear off. The patient may feel swollen or distended abdomen, even nauseated. You may also have a sore throat, which can last 1 to 2 days.