ERCP: Indications and Complications

Your liver produces bile which plays an essential role in the digestion of your food. The bile ducts carry bile from the liver to the gall bladder to the duodenum via the common bile duct. The pancreas produces pancreatic juice which is essential for the breakdown of the food you eat; the pancreatic ducts carry this juice to the duodenum. The common bile duct and the pancreatic duct join before emptying into the duodenum.

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a method that uses x-ray and endoscopy for the diagnosis and treatment of the problems in the bile and pancreatic duct.

Procedure

ERCP is an outpatient procedure. The doctor will ask you to lie on the examination table. Before the ERCP you will be administered a local anaesthetic in the form of a gargle or a spray in your throat to prevent gagging during the procedure. You will also be given sedatives via an intravenous line to help you relax. After this, the doctor will insert a thin tube down your oesophagus into the stomach and the duodenum. Air will be pumped into your stomach and duodenum for easy visualisation.

Your doctor, on locating the opening of the common bile duct and pancreatic duct into the duodenum, will insert a small tube called a catheter into the opening. Through this tube, a fluid containing a contrast dye is injected. This dye helps in the visualisation of the system of ducts in the pancreas and the biliary tract with the help of x-ray. The doctor may insert small tubes through the catheter to

• Insert stent in the tubes
• Remove or break stones
• Perform biopsy or remove tumours
• Open narrowed or blocked ducts.

Indications for ERCP

An ERCP is suggested for patients who have symptoms of obstruction of bile or pancreatic duct due to:

• Infection
• Gallstone, which have become lodged in the common bile duct
• Pancreatitis
• Cancer of bile duct
• Cancer of pancreatic duct
• Pancreatic pseudocyst

Preparation

In preparation for an ERCP, your doctor will ask you to not have anything to eat or drink from 12 hours before the procedure. Your doctor would like to know about the medications you are currently taking and may advise you to stop taking some of them like blood thinners to prevent excessive bleeding from the site where the tissue sample is obtained. You are advised to inform your doctor about any family history of bleeding disorders or any allergies to local anaesthetics or sedatives. If you are diabetic your doctor might adjust the dose of your medications. You are advised to arrange for someone to drive you home because the effect of the sedative takes time to wear off.

If you are pregnant you are requested to inform your doctor so that required precautions are taken to protect the baby from radiation.

Complications of ERCP

The complication of ERCP includes:

• Pancreatitis
• Bleeding
• Infection
• Perforation
• Abnormal reaction to sedative

Recovery

After the procedure, you will be monitored until the effect of the sedative began to wear off. You are requested to arrange for some to drive you home. Your doctor will advise you to rest for the day at home. If you experience any of the following you are requested to contact your doctor immediately:

• Fever with or without chills
• Pain in abdomen
• Black tarry stool
• Vomiting
• Difficulty in breathing
• Pain in chest
• Problem in swallowing.

Resources:

• National Institute of Diabetes and Digestive and Kidney Diseases
• American Gastroenterological Association
• American Society for Gastrointestinal Endoscopy