ERCP is a procedure to diagnose possible disorders of the pancreas and bile duct system. Bile is made in the liver and stored in the gallbladder until food is eaten. Bile is then discharged into the cystic bile duct and travels to the common bile duct. The pancreas produces digestive enzymes that flow into the common bile duct. Together, bile and the pancreatic digestive enzymes travel through the ampulla (the point at which the common bile duct meets the duodenum) and into the duodenum to help digestion.
Conditions that affect this system include:
- Obstruction of the bile duct and pancreatic duct by gallstones, pancreatic stones, tumours or scar tissue.
- Primary sclerosing cholangitis
- Narrowing (stricture) of the ducts
- Chronic pancreatitis (inflamed pancreas)
- Pancreas divisum
- Cancer of the pancreas, ampulla or bile duct.
Common symptoms of these conditions are jaundice or pain in the abdomen.
Your surgeon inserts the endoscope into your mouth and guides it down the oesophagus and through the duodenum to the papilla. Puffs of air may be introduced through the endoscope to provide your surgeon with a better view. Due to this you may have a full feeling.
Once the surgeon can see the ampulla, a small plastic tube (catheter) is threaded through the inside of the endoscope. A dye is then injected into the duct system, and X-ray films are taken. If any abnormal tissue is found, your surgeon may administer various treatments through the endoscope.
Procedures During ERCP
- Biopsy Of Abnormal Tissue: If your surgeon sees abnormal or suspicious tissue, a biopsy (a small piece of tissue) may be taken by forceps applied through the endoscope. This biopsy is painless. The tissue is sent to a pathologist for examination under a microscope. You will receive the results of this examination in about one to two weeks. If your surgeon takes a biopsy, it does not mean that cancer is necessarily suspected because biopsies may be taken for many reasons.
- Strictures: Strictures are a narrowing of the ducts or other passages of the GI tract. They are due mainly to the growth of scar tisuue or cancer. A stricture may be treated by stretching the tissue from the inside using an inflatable balloon, a “bougie” (tapered plastic tube” or other device. In some cases, a stent (an expandable tube made of metal or plastic) can be passed through the endoscope and inserted to widen a stricture. A biopsy may be needed to diagnose the cause of the stricture.
- Removal Of Stones: If a gallstone or pancreatic stone is found during ERCP, it often can be removed through the endoscope. Forceps are passed through the endoscope and a small cut is made to open up the papilla. A second device is passed through the endoscope to remove the stone. Electrocautery is applied to the papilla to stop any bleeding.
Do not eat or drink anything for six hours before your appointment. Your surgeon may give you additional instructions and may recommend a longer period of fasting.
NOTE: If you have diabetes, be sure to discuss your condition with your surgeon before you undertake any period of fasting.
Once your examination (or possibly treatment) is complete, you are escorted to a recovery area. You will not be able to eat or drink for about an hour and may need to stay in the recovery area for up to three hours. Depending on the extent of the treatment you had during the endoscopic procedure, your surgeon may want you to stay overnight for observation. Arrange to have a friend or relative take you home. Do not drive, operate heavy machinery, drink alcohol or make important decisions until the next day (sometimes longer if your recovery is slow).
It is common to have a sore throat for a day or two. Patients often have a full feeling and pass gas for a while after the procedure. Soft stools and changes in bowel movements are common for the first day or so. Stools should NOT be black or contain blood clots; if this occurs, contact your surgeon.