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Endoscopic Retrograde Cholangiopancreatopgraphy (ERCP)

ERCP (Endoscopic retrograde cholangio-pancreatography)

Overview

ERCP (endoscopic retrograde cholangiopancreatography) is a catheterization procedure used to visualize bile ducts inside and outside the liver (intra- and extra-hepatic bile ducts), the common bile duct, the gallbladder and the Wirsung’s canal (the pancreatic duct). As the term implies, a thin, flexible tube equipped with a camera is used in this endoscopic method.


The biliary system is a network of ducts that are located in liver, gall bladder and pancreas. The bile is produced in the liver and stored in the gallbladder, and this fluid functions especially in the digestion and absorption of fats. The pancreas produces enzymes that play an important role in the digestion of foods.


ERCP (endoscopic retrograde cholangiopancreatography) is performed to visualize, diagnose and treat the problems that may occur in this system.


How is ERCP performed?

An endoscope is inserted into oral cavity and advanced to esophagus, stomach and duodenum. A thin cannula is advanced through the endoscope and inserted through the opening of the biliary system in the duodenum; next, a contrast agent is instilled into the biliary system that is clearly visible on X-ray scans. Meanwhile, many abnormalities of the biliary system, including but not limited to gallstones, tumors and narrowing, can be visualized on images rendered by the X-ray device. If an intervention is planned for the bile duct, another cannula with a wire in one end is advanced and the opening of the biliary system is cut using electric current (electrocautery). For example, if a gallstone is present, a basket or a balloon catheter is advanced through the lumen of the endoscopy, the stone is grasped and pulled out. If there is a tumor or narrowing that blocks the flow of file, the stenotic segment can be enlarged with a balloon or a stent is placed to restore bile flow. The procedure usually takes about 20 to 30 minutes. After a successful procedure, you will usually return back to usual life in the same day or the next day.

What are indications of ERCP?

ERCP is most commonly performed to remove gallstones. The procedure is performed to eliminate the blocked bile flow due to migration of gallstone from the gallbladder to the common bile duct. In addition, some other indications of ERCP include tumors of bile ducts and the pancreas, narrowing of bile ducts, leaks in bile ducts (especially secondary to surgical procedures) and some pancreatic diseases.

Is there any alternative to ERCP?

Surgical treatment is also a treatment option for above mentioned diseases. However, this region poses some difficulties for surgical procedures and the complication risk after an open surgical procedure is far higher in comparison to ERCP and the patient has to stay at hospital significantly longer after an open surgery.

What are the complications of ERCP?

ERCP is broadly a safe procedure, but some complications may also develop. The most significant complications include inflammation of pancreas (pancreatitis), bleeding that occur during electrical cut or perforation of intestine. Although these complications can usually be managed with endoscopic intervention, surgical procedure may rarely be required and inpatient treatment can be necessary. Sometimes, the procedure may fail due to anatomical or technical reasons. ERCP is a successful (>95%) and safe procedure, if it is performed by experienced physicians.

Despite all risks, ERCP is the safest procedure in treatment of above mentioned diseases, especially removal of gallstones in bile ducts, and it is the first-line option for interventions to the bile ducts.