What is ERCP?
ERCP is a radiological examination in which the physician can trace the cavities of the bile ducts, the gallbladder (Greek cholé = bile) and the ducts of the pancreas (Greek pán = all, kréas = flesh) back to their origin against the normal direction of flow (retrograde) and evaluate them. To do this, he uses a so-called endoscope – a tube-shaped instrument equipped with a light source and an optical system. The doctor guides this endoscope through the mouth and stomach into the duodenum (= first section of the small intestine) to the point where the bile duct joins the duodenum. From there, the physician fills an X-ray contrast medium into the bile duct via the endoscope; X-rays are then taken.
In addition, small interventions are possible during ERCP, for example the removal of a gallstone from the bile duct.
Gall bladder and pancreas
When is ERCP performed?
With the ERCP examination, the doctor can detect pathological changes in the area of the bile ducts and pancreatic ducts. These include:
- Jaundice (icterus) to clarify an obstruction
- Gall bladder inflammation (cholecystitis)
- Bile duct inflammation (cholangitis)
- Constriction of the bile ducts, e.g. due to gallstones
- Pancreatitis (inflammation of the pancreas)
- Cysts and tumors
What is done during an ERCP?
ERCP is an outpatient procedure after which you can usually go home quickly. Before ERCP, the doctor will discuss with you whether you suffer from clotting disorders or are taking anticoagulant medications. If there is inflammation, an antibiotic will be given beforehand.
Before the examination begins, you will be given medication for a short anesthetic (twilight sleep) through a venous line. Throughout ERCP, your blood pressure, pulse, and blood oxygen levels will be monitored.
Interventions during ERCP
If tumors are suspected, the doctor can take a tissue sample (biopsy) during ERCP. In addition, constrictions can be widened with the help of tubes – so-called stents.
In some cases, it is necessary to split the “papilla vateri” (papillotomy). This is the fold of mucous membrane in the duodenum through which the bile duct and the pancreatic duct open into the intestine. The papillotomy enlarges this common orifice of the ducts.
During ERCP, the doctor may also remove gallstones if necessary.
What are the risks of ERCP?
As with any procedure, potential risks associated with ERCP must be carefully weighed in advance. These include:
- Pancreatitis
- Inflammation of the bile ducts or gallbladder
- Injury to the esophagus, stomach or intestines when inserting the endoscope
- Allergy to the X-ray contrast medium administered
- Difficulty in swallowing, sore throat and hoarseness due to the insertion of the endoscope
- Infections
ERCP during pregnancy should be avoided if possible.
What do I need to be aware of after an ERCP?
After ERCP, you should not eat or drink anything for at least two hours to avoid stimulating the gallbladder and pancreas to release their digestive secretions. Afterward, start with light foods such as tea and rusks. You should also not drive or operate machinery or drink alcohol on the day of ERCP. If you suddenly feel unwell and develop a fever, severe pain or bleeding, please notify your doctor immediately.
