Gastroenterology includes diseases of the biliary tract and pancreas. ERCP allows detailed investigation of the pancreatic and biliary system and more importantly allows therapeutic interventions for pancreatic and biliary diseases. In recent years, the diagnostic role of ERCP has diminished and has been replaced by noninvasive tests such as MRCP (Magnetic resonance cholangiopancreatography). ERCP now is typically used in a therapeutic role when an intervention is strongly suspected or confirmed by noninvasive testing.
- Do not eat or drink after midnight.
What is ERCP?
ERCP is an advanced endoscopic procedure performed under monitored anesthesia care (MAC) administered by an anesthesiologist, typically using Propofol as the anesthetic agent. After the patient is sedated, a specialized endoscope (duodenoscope) is passed to the second portion of the duodenum to image the ampulla. The ampulla is a small pinhole-like opening that drains the confluence of the bile duct and the pancreatic duct. The bile duct drains bile from the liver and the pancreatic duct drains pancreatic secretions from the pancreas. Through the endoscope, access to these ducts is achieved by threading wires, catheters, and other devices into these ductal systems. Then using fluoroscopy, a form of real time X-ray, radiographic imaging of the pancreatic and biliary ductal systems is achieved. While maintaining access to the biliary or pancreatic duct, various therapeutic maneuvers such as removal of gallstones and dilation or stenting of strictures can be performed. Stenting is the placement of a removable tube within either duct to allow drainage if an obstruction is present. Often, the pin-hole-sized ampullary orifice needs to be enlarged to allow therapeutic procedures by cutting it open. This is known as a sphincterotomy.
Risks to ERCP include the risks of the anesthesia in addition to bleeding, infection, perforation, and possibly pancreatitis. Pancreatitis is in inflammatory reaction of the pancreas which can be mild to severe, and is uncommon, but not rare.
What is the preparation for ERCP?
Preparation for ERCP is similar to an upper GI endoscopy. Nothing to eat or drink after midnight on the night before the test except sips of liquids with medications. Blood thinners except for aspirin usually need to be held prior to the test and should be discussed with the gastroenterologist and prescribing MD.