ERCP
What is ERCP?
Endoscopic
Retrograde
Cholangio

Pancreatography


Endoscopic refers to the use of an instrument called an endoscope - a thin, flexible tube with a tiny video camera and light on the end. The endoscope is used by a highly trained subspecialist, the gastroenterologist, to diagnose and treat various problems of the GI tract. The GI tract includes the stomach, intestine, and other parts of the body that are connected to the intestine, such as the liver, pancreas, and gallbladder.

Retrograde refers to the direction in which the endoscope is used to inject a liquid enabling X-rays to be taken of the parts of the GI tract called the bile duct system and pancreas.

The process of taking these X-rays is known as cholangiopancreatography. Cholangio refers to the bile duct system, pancrea to the pancreas.

Who should undergo ERCP?

ERCP may be useful in diagnosing and treating problems causing jaundice (a yellowing of the whites of the eyes) or pain in the abdomen. Bile is a substance made by the liver that is important in the digestion and absorption of fats. Bile is carried from the liver by a system of tubes known as bile ducts. One of these, the cystic duct, connects the gallbladder to the main bile duct. The gallbladder stores the bile between meals and empties back into the bile duct when food is consumed. The common bile duct then empties into a part of the small intestine called the duodenum. The common bile duct enters the duodenum through a nipple-like structure called the papilla.

Joining the common bile duct to pass through the papilla is the main duct from the pancreas. This pathway allows digestive juices from the pancreas to mix with food in the intestine. Problems that affect the pancreas and bile duct system can, in many cases, be diagnosed and corrected with ERCP.

Problems with the bile ducts or pancreas may first show up as jaundice or pain in the abdomen, although not always. Also, there may be changes in blood tests that show abnormalities of the liver or pancreas.

How do I prepare for the Procedure?

First of all give a complete list of all the medicine you are taking as well as any allergies you have to drugs and other substance. Regardless of the reason for OGD Scopy, there are important steps you can take to prepare and participate in the Procedure. Let your doctor know if you have heart, Lung or other medical conditions that may need special attention before during and after OGD Scopy.

One very important step in preparing for OGD Scopy is that you should not eat or drink within 6 hrs of your procedure. Food in stomach blocks the view through endoscope and it could cause vomiting.

You will be given the instructions in advance that will outline what you should and should not do in preparation.

It can be done as in patient or outpatient basis depending upon the indication and procedure. You will be asked to sign a consent form for the procedure. If there is anything you do not understand, please ask for more information. Get a family member or friend to accompany you for the procedure.

What can you expect during an ERCP?

Everything will be done to ensure your comfort. Your blood pressure, pulse, and the oxygen level in your blood will be carefully monitored. A sedative will be given through a vein in your arm. You will feel drowsy, but will remain awake and able to cooperate during the procedure.

Although general anesthesia is usually not required, you may have the back of your throat sprayed with a local anesthetic to minimize discomfort as the endoscope is passed down your throat into your esophagus (the swallowing tube), and through the stomach into your duodenum.

The doctor will use it to inspect the lining of your stomach and duodenum. You should not feel any pain, but you may have a sense of fullness, since air may be introduced to help advance the scope.

In the duodenum, the instrument is positioned near the papilla, the point at which the main ducts empty into the intestine. A small tube known as a cannula is threaded down through the endoscope and can be directed into either the pancreatic or common bile duct. The cannula allows a special liquid contrast material, a dye, to be injected backwards - that is, retrograde - through the ducts.

X-ray equipment is then used to examine and take pictures of the dye outlining the ducts. In this way, widening, narrowing, or blockage of the ducts can be pinpointed.

Some of the problems that may be identified during ERCP can also be treated through the endoscope. For example, if a stone is blocking the pancreatic or common bile duct, it is usually possible to remove it.

First, the opening in the papilla is cut open and enlarged. Then, a special device can be inserted to retrieve the stone. Narrowing or obstruction can also have other causes, such as scarring or tumors. In some cases, a plastic or metal tube (called a stent), can be inserted to provide an opening. If necessary, a tissue sample or biopsy can be obtained, or a narrow area dilated.

What can you expect after Your ERCP?

When your ERCP is completed on an outpatient basis, you will need to remain under observation until your doctor or healthcare team has decided you can return home. Sometimes, admission to the hospital is necessary.

When you do go home, be sure you have arranged for someone to drive you, since you’re likely to be sleepy from the sedative you received. This means, too, that you should avoid operating machinery for a day, and not drink any alcohol.

Your doctor will tell you when you can take fluids and meals. Usually, it is within a few hours after the procedure.

Because of the air used during ERCP, you may continue to feel full and pass gas for awhile, and it is not unusual to have soft stool or other brief changes in bowel habits. However, if you notice bleeding from your rectum or black, tarry stools, call your doctor.

You should also report vomiting, severe abdominal pain, weakness or dizziness, and fever over 100 degrees. Fortunately, these problems are not common.

What are post ERCP orders to be followed?

Fasting following OGD Scopy will be determined based upon the findings and the procedures performed. In most patients oral liquids can be started ½ hr of the procedure and later full diet. Treatment for you will be explained by the doctor.

 
 
Director's Corner
DR. SUSHIL LOHIYA
M.B.B.S., M.S.
General Surgery
(Sion, Mumbai)
Fellow in Bariatric & Metabolic Surgery
 
 
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