ERCP is used for the detection and treatment of diseases of the bile ducts, liver, gallbladder and pancreas. Gastroenterologist introduces an endoscope (a thin flexible tube) through the mouth into duodenum, up to the papilla (a small, usually common duct of gallbladder and pancreas). A contrast agent is then injected through the papilla, which enables an X-ray display of the biliary and pancreatic ducts.
Good results with minimal complications are achieved in close collaboration of a well-tuned team, consisting of an experienced endoscopist, endoscopy nurse and a radiologist. At Diagnostic Centre Bled, this examination is performed by gastroenterologists, expert endoscopists with a long-standing practice and experience with a number of diagnostic and endoscopic surgeries.
The most common indications for ERCP are:
- diagnosis and removal of gallstones in the bile ducts,
- identifying the causes for obstructed outflow of bile, when the latter is suggested by for example jaundice, laboratory findings or the results of other diagnostic methods (ultrasound, CT, MRCP, EUS)
- identifying the causes and consequences of pancreatitis (inflammation of the pancreas)
- assessment of potential occurrence of pancreatic or bile duct cancer,
- identifying the causes for chronic and acute abdominal pain, when it is suspected that it could be associated with the disease of bile ducts or pancreas.
During the examination, we will do everything to make you feel as comfortable as possible. Prior to the procedure, you will be injected with a medication which will calm you down, or sometimes with such medication that will make you sleepy. Your pharynx will be numbed with a local anaesthetic. In order to protect the teeth, we will insert a mouthpiece in your mouth. While you are lying on your left side, the doctor will introduce the endoscope. The endoscope should not cause any pain, and you may also continue to even breathing problems you'll have.
Sphincterotomy: If the X-ray imaging shows gallstones or any other cause of obstruction, the doctor will cut the bile duct. This procedure (sphincterotomy) will be carried out utilizing a special electric cutting instrument (sphincterotome or needle knife), and you will not feel anything. Smaller stones will fall into duodenum on their own, while larger will be crushed and then retrieved with a special basket.
Endoprosthesis (stent): stent is a small tube, which is inserted through the endoscope, and then through the bile duct stricture, which restores the unobstructed flow of bile. Stents are also inserted into the pancreatic duct, if it is narrowed or closed.
Nasobiliary probe: sometimes a transient (a few days) insertion of a special tube into the bile or pancreatic duct is required; it is inserted through the nose. It enables drainage and adequate rinsing of the ducts, as well as X-ray imaging to check whether the bile duct is clear. Such probe causes some discomfort only at the beginning, but it does not interfere with the consumption of food and liquids.
We recommend ERCP because it is a simpler and safer method than standard surgery. However, you should be aware that it is not always successful and it can also induce complications, since each examination, or interference with the human body, represents a certain risk.
- Pancreatitis (inflammation of the pancreas, the organ which lies behind your stomach) occurs after ERCP in 3-5% of patients (about one in thirty to one in twenty subjects). If it comes to this, the inflammation is usually mild and causes abdominal pain with nausea and vomiting, which subside within a few days of hospitalization. Very rarely, pancreatitis is so severe that it presents a serious and life-threatening complication.
- The endoscope and other instruments can tear or puncture the examined tissues and organs. This is a serious, but fortunately a very rare complication that may require surgery.
- The bleeding which may occur after the biopsy or cutting the papilla, is usually minimal and ceases quickly, by itself, or it can be stopped endoscopically; it rarely requires surgery.
- Food or liquids may accidentally get into the lungs (aspiration), which can lead to pneumonia. Preoperative fasting significantly reduces the risk.
- Infection of bile ducts (cholangitis) is a rare complication, which may require a prolonged antibiotic treatment, or even another ERCP or other surgical procedure.
- Potential adverse reactions to medications that are used during surgery (sedatives, painkillers, antibiotics, etc.). Before the procedure, the doctor will ask you whether you may be allergic to any medication, and whether you may have health problems with heart, lungs, kidney or liver. Knowing this information will allow for a safer procedure.
- Medications can also cause a local irritation at the site of venipuncture (the site of puncture into a vein) or intravenous line. If there is any redness, swelling, or fever, the inflammation can be alleviated by cataplasms.
In the coming months or years, the problems seldom re-occur. You may develop jaundice, fever or newly formed gallstones in the bile duct. Usually, these complications can be resolved by another endoscopic procedure.
The stents (endoprosthesis, tubes) can become clogged only after a few months. This will cause another jaundice episode, usually accompanied by hypothermia. If this happens, contact your doctor as soon as possible. You will need an antibiotic and will need to consider a stent replacement.
You will need to stay at the Diagnostic Centre for at least one day after the procedure. In the event that you came from another hospital, an ambulance will take you back. Please, inform us about any severe abdominal pain (not just cramps), vomiting, hypothermia, and bloody or tarry stools. To determine whether an irritation of the pancreas or other complications have occurred, we will perform a blood test on the day after the procedure. We will instruct you when and what to drink and eat, normally this is possible on the next morning after ERCP.