ERCP (Endoscopic Retrograde Cholangiopancreatography)

Endoscopic retrograde cholangiopancreatography (ERCP) is a medical technique or procedure used in the diagnosis and treatment of conditions affecting the pancreatic and bile duct region of the human body.

What is Endoscopic retrograde cholangiopancreatography (ERCP)?

As the term implies, ERCP is comprised of a telescopic endoscope used with a dye to take X-ray pictures or images of the bile and pancreatic duct. This process is called Cholangiopancreatography and is used for diagnostic and treatment purposes.

When does a doctor recommend ERCP?

When patients experience symptoms of illness or bleeding in the upper and lower digestive tract, ERCP may be used to try and determine the cause. Symptoms may include fever, jaundice, abdominal pain and weight loss. Any symptoms that could indicate disease may lead a doctor to recommending ERCP for diagnostic reasons. Diseases or conditions may include:

  • Biliary disease, obstruction or stricture.
  • Primary biliary cirrhosis (PBC).
  • Pancreatic pseudocysts, divisum or inflammation (pancreatitis).
  • Gallstones in the gallbladder or bile ducts, inflammation or injury (including abdomen).
  • Tumours or cancer.
  • Cholangitis or infection of the bile ducts caused by bacteria or parasites.
  • Sclerosing cholangitis: inflammation of bile ducts.

ERCP and the digestive tract

ERCP is primarily used to diagnose and remedy conditions originating from and affecting the pancreatic and bile duct regions. The pancreas is located below the liver and gallbladder, under the upper duodenum that leads from the stomach but just above the upper colon. The gallbladder is located almost within the lower region of the liver and is just above the upper duodenum leading from the stomach. The ducts of the liver, gallbladder, bile and pancreas (papilla) feed into the duodenum.

All these organs work together to secrete and circulate fluids via the ducts, through the body's blood supply and tissues, and out as toxins through the anus attached to the colon. The fluid created by the pancreas consists of proteins used for digestion of other substances, like proteins, carbohydrates and fats. The liver produces bile that builds up in the gallbladder to be released through the small intestine.

How is ERPC used within the digestive tract for diagnosis?

Before the procedure you should not eat 8 hours, you must disclose any allergies you have and the physician will give you other instructions. Once sedated the ERCP endoscope is placed into the patient's mouth and the thin, flexible tube attached to its side containing fibre-optic channels and telescope is directed into the oesophagus, the stomach and duodenum. The practitioner is able to inject radio-contrast dye through the papilla of the pancreas up into the pancreatic and bile ducts. By taking X-rays or fluoroscopic images of the pancreatic and bile ducts as the dye flows through it, the practitioner can then identify any blockages or conditions such as those mentioned previously.

What procedures are used as alternate or in tandem with ERCP?

Practitioners may opt to use other techniques either alone or with ERCP procedures, such as endoscopic ultrasound, ultrasonography, high-resolution computer tomography scans (CT) and magnetic resonance imaging (MRI).

How is ERCP used for treatment?

An endoscope is inserted through the stomach into the ducts. An endoscope can be used as a telescope for imaging – as an injector of dye or medications – it can also be used with electrified wire (sphincterotomy) or electrohydraulic lithotripsy to remove gallstones and lesions; with a balloon to remove gallstones; to insert a stent for bile or pancreatic drainage and to cauterise. A form of double endoscope can be used when another is inserted and passed through the first endoscope channel, as in Duodenoscope-assisted Cholangiopancreatoscopy (DACP), which can replace X-rays or can deliver an electrical current.

What are the benefits of ERCP?

The benefits of ERCP include being able to use an endoscope for both diagnosis and treatment of diseases or conditions affecting the liver, pancreas and gallbladder. ERCP can be used during many life-saving procedures, such as the removal of tumours and stones, the placement of stents, as an aid to dilation and during liver transplant operations.

What are the risks of ERCP?

EPCP, as with any medical procedures, does pose risks, though practitioners will have been trained to keep such risks to a minimum. A low ratio of people undergoing an ERCP procedure may experience pancreatitis, particularly those who have had previous pancreatitis and injections within the pancreatic duct. Other risks include perforation of digestive tract structures and bleeding. Sedation may lower respiratory function and blood pressure. Vomiting and nausea may be a complication, as is an allergic reaction to the iodine in the radiocontrast dye. Such risks can be minimised through competent technique and checking a patient’s history.

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