ERCP is the combination of an endoscopy and an X-ray evaluation of the bile ducts and the pancreatic duct. Ducts are tubes – the bile duct drains bile from the liver into the small intestine. The gallbladder connects to the bile duct via the cystic duct. The pancreatic duct travels through the middle of the pancreas and joins the bile duct at the sphincter of Oddi. Initially ERCP is similar to upper endoscopy. When the tip of the scope reaches the ampulla of Vater where the sphincter of Oddi resides, a catheter is placed into the opening and then X-ray contrast is injected and X-ray films are obtained to look at the ducts.
The most common reasons for ERCP are abdominal pain suggestive of gallstones, jaundice, pancreatitis and evaluation of abnormal ducts as seen by radiological studies.
A person undergoing this procedure should have an empty stomach, meaning nothing to eat or drink for about 6 hours before the test. Because sedation is given, a designated driver is necessary to take the patient home after the procedure. If a patient is taking Coumadin, changes in the dosing may be needed. Intravenous antibiotics may be required if there are risk factors for infection of the heart valves. For a number of conditions, the patient may stay overnight for observation.
Remember not to eat or drink for over 6 hours prior to the procedure. The local anesthesia and intravenous sedative takes away any sensation of gagging.
The actual procedure lasts between 30 and 45 minutes.
Generally the majority of our patients do not feel or remember anything. If pancreatitis occurs, the pain does not usually start until 4 hours after the procedure.
Sphincterotomy is enlarging the opening of the ampulla by cutting the muscles of the sphincter using a catheter with an electrocautery wire. If a stone is seen in the bile duct, a sphincterotomy and stone extraction can be performed. If scar tissue, narrowing or spasm of the sphincter is suspected, measurements called manometry can be performed and then be followed by sphincterotomy as indicated. Sampling of cells (cytology) can be performed in areas of narrowed ducts. If malignant obstruction of the ducts is seen, a plastic or expandable metallic stent (hollow tube) can be placed.
The risks of injecting contrast into the ducts are infection and pancreatitis. The risks of sphincterotomy are bleeding and perforation