ERCP (Endoscopic retrograde cholangiopancreatography)

Apr 14, 2012 , Jiří Dyntr

ercp.jpg - kopie
ercp.jpg - kopie
ERCP or endoscopic retrograde cholangiopancreatography is an endoscopic examination, by which tissue samples can be taken, patency of the pancreatic duct and common bile duct can be determined, or places, which previously could be viewed only during surgery, can be visualized. ERCP is a much more considerate examination to the patient and complications associated with surgery, are reduced to a minimum.

ERCP (Endoscopic retrograde cholangiopancreatography)

ERCP or endoscopic retrograde cholangiopancreatography is an examination through which you can detect diseases of the liver, gallbladder and pancreas. It is a method which combines X-rays with an endoscope, thus a tubular instrument containing a camera, through which physicians can visualize the state of the above mentioned organs and their other parts. Liver is the largest organ of the body with many irreplaceable features. One of them is the production of bile, which is stored in a bag-like organ, the gallbladder. If the body needs to digest food components then bile is released into the common bile duct, which leads into the duodenum together with the pancreatic duct. By ERCP it is possible to view all these areas and to determine the most frequent causes of jaundice, or abdominal pain in the upper abdomen.

Principal of ERCP

ERCP belongs to the endoscopic examinations during which a special tube with its own lighting and camera is introduced into various hollow organs, so the doctors examine places that were previously accessible only by surgery. The endoscope in addition to lights and cameras also contains a working channel, by which can be transported to the target organ different types of small forceps and other equipment for sampling of tissue, called a biopsy or suction to remove fluids. It is also possible to inflate some organs with air by the working channel, which provides the doctors better conditions for examination.

ERCP procedure

During ERCP the patient lies on his left side and gets drugs that numb the back of the throat and tranquillizers. Regular breathing is important for suppressing nausea. During ERCP the movable head of the endoscope is introduced into the digestive tract through the mouth and through the esophagus and the stomach till it reaches the small intestine. In the first part of the small intestine, the duodenum, where lead the pancreatic and common bile duct, the endoscope stops and through the working channel a thin rod is inserted into the intestine. Then the rod is inserted into the duct and a special contrast agent is injected in it so it is visible by X-ray. With the help of X-rays, doctors examine both ducts and can detect their narrowing or other damage. The X-ray examination is recorded and can be transformed to classic X-ray images. The entire examination takes 30 minutes to an hour, but if the surgeon eliminates gallstones it can take up to two hours.

Preparing the patient for ERCP

At least 12 hours before the examination you should not eat, smoke or drink alcoholic beverages, so there are no pieces of food in the digestive tract. It is also necessary that the patient reports all medication and allergies. Important is primarily an allergy to iodine, which is included in the contrast agent. From drugs are most important anticoagulants like, heparin, warfarin, anopyrin, or aspirin because of the risk of bleeding. Then a numbing spray is applied into the patient's throat and the doctor gently introduces the endoscope tube. During the examination, the patient is advised of the next steps and his reactions are closely monitored. Due to the effect of the anesthetic agents, patients should not drive a car immediately after the procedure. Therefore, it is necessary to arrange a drive-away before leaving the hospital.

Complications of ERCP

During ERCP, as during any examination, certain complications may occur. Possible complications include pancreatitis, infection, bleeding, or rupture of the duodenum. However these complications of ERCP are not very frequent. An unpleasant complication is also undetected or undeclared allergy especially to iodine. It is contained in the contrast agent that is injected during the examination into the duct. A result of the allergic reaction can be anaphylactic shock, which directly threatens the patient's life. Complications also arise when the digestive tract is insufficiently evacuated, since the insertion of the tube evokes vomiting. That could lead to aspiration of the vomitus and choking of the patient.

Advantages of ERCP for the patient

ERCP is a very useful and effective method that allows the diagnosis and often also treatment of gallbladder, liver and pancreatic problems. With this method it is possible to diagnose nonspecific abdominal pain in the upper abdomen, or jaundice. Even though it is slightly uncomfortable for the patient, it may save you a complex and certainly more unpleasant surgery, what for sure each of us will welcome.

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