ERCP


Treatment Option for Blockages of the Bile or Pancreatic Ducts

ERCP, which stands for endoscopic retrograde cholangiopancreatography, is a minimally invasive procedure performed by gastroenterologists in order to relieve blockages within the bile or pancreatic ducts (the tubes that carry bile from the liver and digestive juices from the pancreas into the small intestine). Common causes of these obstructions are stones, strictures, or tumors.

During an ERCP, the gastroenterologist gently inserts an endoscope into the mouth of a patient and then advances that endoscope through the stomach into the duodenum, the small intestine just downstream of the stomach. The endoscopist identifies the location where the bile duct connects with the small intestine, cautiously feeds a guidewire and tiny catheter (plastic tube) into the duct, injects a contrast agent, and takes X-rays. The contrast agent allows the bile ducts and/or the pancreatic duct to be visualized on the X-ray screen to identify any abnormalities.

Inserting a guidewire or catheter into the bile or pancreatic ducts is tricky because a sphincter muscle located at the bottom of the ducts, which acts like a valve, is difficult to navigate. Usually, after accessing the bile and/or pancreatic ducts, your doctor will make a small incision to cut open the sphincter muscle (sphincterotomy) in order to facilitate other actions that may be needed to relieve the obstruction. If the bile duct is blocked by a stone, the sphincterotomy will help with the removal of the stone, and if a tumor is causing the obstruction, sphincterotomy will make placement of a stent easier and safer. (A stent is a tube made out of either plastic or metal that enables bile or pancreatic juice to drain through it into the small intestine.)

As with other medical procedures, ERCP involves some risk. In about 7 out of 100 procedures, the pancreas can become irritated causing pancreatitis, a painful condition that generally requires a hospital stay. Most of the time that stay is three days or less, but rarely the pancreatitis can be severe. Bleeding may occur after 2-3% of cases, and either a blood transfusion or another endoscopy procedure to stop the bleeding may be necessary. Very rarely (approximately 1 in 2500 procedures,) there may be a perforation or tear in the small bowel which requires surgery to correct. These procedural complications are uncommon, and it is important for you to know that our doctors always do everything in their power to avoid them.

The alternatives to ERCP are PTC (an interventional radiology procedure where a needle is pushed through your ribcage into the bile duct, allowing access by various devices which are used to relieve an obstruction), or open surgery. Those alternatives are more invasive and involve more risks than ERCP, which is why ERCP is usually the first option considered to relieve blockages of the bile or pancreatic ducts.

Stephen Schutz, MD

ERCP

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