These summaries were prepared by Dr Felicity Goodyear-Smith, Goodfellow Unit, Department
of General Practice & Primary Health Care, University of Auckland. Thanks for
the material provided by Ms Sarah Marshall, Charge Nurse Manager, Department of
Gastroenterology & Hepatology, A+, Auckland.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
About ERCP
Procedure Details
Description of procedure
Endoscopic Retrograde Cholangiopancreatography (ERCP) involves the use of an endoscope
to image and treat disorders of the gallbladder, bile ducts, and pancreas. Using
the special ERCP videoscope, the gastroenterologist locates the ampulla, inserts
a small catheter through the sphincter of Oddi and injects radio-opaque dye so that
X-rays can be taken of the bile and pancreatic ducts. Treatment may also be undertaken
during ERCP: for example, removal of stones from the bile duct dilation of strictures,
biopsy of tumours or insertion of stents to bypass obstruction. The test takes 30
to 90 minutes to perform and is usually painless to the patient who is sedated.
Advantages of ERCP:
- Safe and highly effective diagnostic technique
- Accurate method of diagnosing and treating conditions of the bile and pancreatic
ducts
- Simpler than exploratory surgery
- Can prevent the need for major abdominal surgery
- May help with planning for surgery
Alternatives to ERCP:
- CT scan of the abdomen
- Percutaneous transhepatic cholangiogram (access to bile duct via needle through
liver)
- Exploratory surgery
Disadvantages of ERCP:
Same risks as associated with gastroscopy:
- Complications rarely occur. Possible complications include bowel perforation or
haemorrhage, which might require surgical repair or blood transfusion respectively
- Risk of perforation or haemorrhage is increased when polyps are removed via the
endoscope
- The procedure requires a hospital stay (usually on an out-patient basis)
- Sedation is required, with a small risk of adverse reactions to medications used
- There is a degree of patient discomfort
- There is a very small risk of contracting hepatitis, the AIDS virus or disease-causing
bacteria and viruses, should there be inadequate cleaning and disinfection of the
instrument after each use
Risks specific to ERCP:
- Pancreatitis (3 to 5% of cases)caused by inflammation of pancreas and release of
pancreatic secretions into surrounding tissue. Usually resolves within 48 hours,
but can be more severe in less than 1% of cases. This could result in a prolonged
hospitalisation, diabetes, fat malabsorption, and in rare cases, death
- Sphincterotomy to relieve an obstruction or remove a stone can result in bleeding
and perforation of the bowel(1 to 3% of cases). On rare occasions these can require
surgery
- Infection of the bile duct
- Incomplete removal of stones
- As X-rays are used, it is important that women are not pregnant when they have an
ERCP
- Adverse reaction to X-ray contrast dye
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Patient Information
This patient information is available
as a PDF file from which you may print copies - you will need an acrobat
reader.
Information for the patient on endoscopy of the upper GI tract
In order to diagnose and treat you, an examination called Endoscopic Retrograde
Cholangiopancreatography (ERCP) has been requested. Endoscopy is a special technique
for looking inside the body. ERCP uses endoscopy to investigate and treat disorders
of the gallbladder, bile ducts, and pancreas.
Bile is a yellowish-green fluid which is released into the small intestine to helps
digest food. It is made in the liver, collected by a series of ducts, stored in
the gallbladder and drained into the intestine (duodenum) via the common bile duct.
The pancreatic duct also drains into the common bile duct. Your common bile duct
therefore connects your liver, gallbladder, and pancreas to your small intestine.
The opening of the common bile duct into the intestine is controlled by the sphincter
of Oddi, a circular muscle which opens and closes to allow bile to pass into your
small intestine.
Preparation
Please keep your appointment if at all possible. Because of the preparation required
for the investigation, your appointment may not be used by someone else if you cancel
just before your scheduled time or if you fail to attend.
Your upper GI tract needs to be empty for ERCP to be performed. You will be asked
to have nothing to eat or drink for at least 8 hours before the gastroscopy.
What the procedure involves
This procedure is done in the X-ray department. You will be asked to lie on your
stomach on an X-ray table where an injection will be given to keep you relaxed and
comfortable. Following this a flexible tube (the gastroscope) will be passed into
your mouth, advancing through to the stomach to where the pancreatic and bile ducts
open. This tube will not block your breathing.
X-ray contrast fluid will be put into your bile and pancreatic ducts via the gastroscope.
Pictures of the image will be taken using X-rays. Please let your doctor or nurse
know if you have had an allergy or reaction to X-ray contrast fluid. If the bile
duct looks blocked, a small cut called a sphincterotomy may be made at the lower
end. This will help the bile to flow, or assist with the removal any stones that
may be seen.
If there is a blockage in the bile duct, a small hollow plastic tube called a stent
may be inserted to help drain the bile internally. In some instances it is preferable
to temporarily allow external drainage of bile through a fine tube which will come
out of the nose into a bag (called naso-biliary drainage).
After the ERCP a nurse will check your temperature, blood pressure and heart rate
hourly. If these recordings are satisfactory and you are comfortable, you will be
able to take water after 2 hours and food after 4 hours.
You are not able to drive or operate machinery for 8 hours after the procedure,
so please have transport organised to get you home.
Elderly patients undergoing gastroscopy are advised to have a support person who
transports them home and stays with them for several hours.
General risks associated with endoscopy:
- Gastroscopy is a safe procedure and complications are very rare. Major complications
occur once in every 7000 procedures. If you wish to discuss risks further with the
doctor, please ask.
- You may experience a sore throat for a day or two.
- Please note that any crown or bridging work may be at risk during the gastroscopy
if your reaction is such that you clench or grind your teeth. Otherwise, your teeth
are not at risk during this procedure.
- Perforation (making a hole in the bowel) or major bleeding from the bowel is extremely
rare but if it occurs, may require an operation. When polyps are removed during
the examination there is a slightly higher risk of perforation or bleeding. In the
unlikely event of haemorrhage occurring, a blood transfusion may be necessary.
- There is a very small risk of adverse reaction to one of the drugs used in the procedure.
For this reason, please let your doctor know all the medicines you are taking and
any allergies you have to drugs or other substances.
Added risks specific to ERCP:
- This test has some specific complications associated with injecting and instrumentation
of the pancreatic duct. The most frequent complication by far is that of pancreatitis.
In about 3 to 5% of cases, the pancreas gland becomes inflamed after ERCP and releases
potent digestive juices directly into the surrounding tissue causing pancreatitis.
Symptoms of pancreatitis include abdominal and back pain, nausea, and vomiting.
In most cases, this complication gets better within 48 hours, but can be more severe
in less than 1% of cases. This could result in a prolonged hospitalisation, diabetes,
fat malabsorption, and in rare cases, death.
- If the bile duct sphincter is cut to relieve an obstruction or remove a stone, bleeding
and perforation of the bowel may occur in 1 to 3% of cases. On rare occasions these
can require surgery.
- Infection of the bile duct
- Incomplete removal of stones.
- As X-rays are used, it is important that women are not pregnant when they have an
ERCP.
- Adverse reaction to X-ray contrast dye.
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