Endoscopic retrograde cholangiopancreaticography (ERCP) is an X-ray-based imaging procedure. It is used to image the biliary and pancreatic ducts. This method is an invasive diagnostic procedure and therefore carries risks.
What is endoscopic retrograde cholangiopancreatography?
ERCP is an X-ray-based imaging procedure. It is used to image the biliary and pancreatic ducts. Endoscopic retrograde cholangiopancreaticography is often performed when biliary or pancreatic disease is suspected. This is an invasive diagnostic procedure that uses X-rays. This procedure can detect pathological changes in the biliary and pancreatic ducts. It is used only when examination by magnetic resonance cholangiopancreatography (MRCP) does not yield clear diagnostic results. MRCP, unlike ERCP, is a noninvasive procedure. However, sometimes not all changes are detected by this method. However, if undiagnosed changes are present in this area, they can be clearly visualized by ERCP. In addition to diagnostic examinations, minor surgical procedures are also performed when necessary. The term “endoscopic retrograde cholangiopancreatography” denotes the use of an endoscope that inserts a probe into the bile or pancreatic ducts retrogradely, i.e., from the exit, with the use of contrast media, where this area is imaged.
Function, effect, and goals
Endoscopic retrograde cholangiopancreatography is used in cases of suspected gallstones, narrowing of the bile ducts due to inflammatory changes or tumors of the bile duct, and chronic inflammation, cysts, or tumors of the pancreas. It is an invasive examination method that uses X-rays to image the bile and pancreatic ducts. Due to the risks associated with radiation, contrast media and the invasive procedure, this method is only performed if MRCP and ultrasound examinations have not yielded any results. During ERCP, minor surgical procedures can be undertaken if necessary. This concerns the removal of tissue samples, widening of the mouth of the ductal systems, expansion or bridging of constrictions by stents. The procedure of endoscopic retrograde cholangiopancreatography is similar to a gastroscopy. An endoscope attached to a tube is inserted through the mouth beyond the stomach into the duodenum. There, contrast medium is injected at the Vater’s papilla against the direction of outflow of bile and pancreatic secretions (retrograde) and a probe is extended from the endoscope. The probe is then inserted into the bile or pancreatic ducts via the Vater’s papilla. The Vater’s papilla represents the common exit of the bile and pancreatic ducts. At the end of the device there is a light source and a camera. This allows this area to be visualized. The probe (catheter) uses X-rays to record the inside of the bile and pancreatic ducts and can thus detect stones, strictures or tumors. If necessary, small interventions can also be performed. For example, the papilla of Vater may be too narrow, causing a bile outflow obstruction. Using the endoscope, the opening of the papilla can be widened. For this purpose, it is cut open with the help of a special catheter with an electrically moved wire. In the case of narrowing of the ducts due to inflammation or tumors, so-called stents made of plastic or metal tubes are often inserted to restore the outflow of bile and pancreatic secretions. The bile duct can also be examined with a sonographic probe. This method is called intraductal ultrasound. Gallstones that are close to the bile duct can also be removed with the endoscope. The main purpose of ERCP is to diagnose gallstones, bile duct carcinomas, inflammation of the bile ducts, pancreatic carcinomas, and unclear biliary outflow obstruction. The advantage of endoscopic retrograde cholangiopancreaticography is the detection of changes in the biliary and pancreatic ducts without the need for open surgery.Therefore, purely diagnostic ERCP can be performed on an outpatient basis.
Risks, side effects, and hazards
Endoscopic retrograde cholangiopancreatography is very good at detecting undetected changes in the biliary and pancreatic ducts. However, like any invasive procedure, it also carries certain risks. The examination is performed under a short anesthesia. As with any anesthesia, the usual risks of anesthesia may occur. In advance, it must be clarified with the patient whether there are any allergies to certain anesthetics and contrast media. Under certain circumstances, the contrast medium can irritate the bile ducts and the pancreas. Therefore, in rare cases, the development of pancreatitis is possible. The procedure may also cause injuries to the larynx, esophagus b.w. Gastrointestinal wall with corresponding bleeding may occur. The risks of X-rays should also be taken into account. Therefore, this method should be performed only if there is no other possibility of a meaningful diagnosis. Especially pregnant women are not recommended to undergo this procedure, because the unborn child is endangered by the influence of X-ray radiation. In advance of the procedure, it is important that the patient is informed about the risks. During this discussion, important questions about allergies, previous illnesses or medication should also be clarified. Medications that thin the blood can increase the risk of bleeding during this procedure. Therefore, it must be clarified with the doctor in what context the examination can still be performed. Perhaps the risk of bleeding is not so high or it is possible to temporarily stop taking blood thinners. For the examination to be successful, it is also important that there is no food debris in the digestive tract. Therefore, patients should urgently follow the physician’s instructions for at least six hours of food abstinence before ERCP.