Treatments & Therapies

Endoscopic Retrograde Cholangiopancreatography – Treatment, Effect and Risks

Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography ( ERCP ) is an imaging procedure based on X -ray radiation . It is used to visualize the bile and pancreatic ducts . This method is an invasive diagnostic procedure and therefore also involves risks.

What is Endoscopic Retrograde Cholangiopancreatography?

If bile duct or pancreatic disease is suspected, endoscopic retrograde cholangiopancreatography is often performed. This is an invasive diagnostic procedure that works with the help of X-rays.

With this procedure, pathological changes in the area of ​​​​the bile and pancreatic ducts can be detected. It is only used when the examination by magnetic resonance cholangiopancreatography (MRCP) does not bring clear diagnostic results. In contrast to ERCP, MRCP is a non-invasive procedure. However, sometimes not all changes are detected with this method.

If there are undiagnosed changes in this area, these can be clearly displayed by the ERCP. In addition to the diagnostic examinations, small surgical interventions are also carried out if necessary. The term “endoscopic retrograde cholangiopancreaticography” denotes the use of an endoscope , which retrogradely, i.e. from the exit, inserts a probe into the bile or pancreas ducts using contrast media and depicts this area there.

Function, effect & goals

Endoscopic retrograde cholangiopancreatography is used in suspected gallstones , narrowing of the bile ducts due to inflammatory changes or tumors in the bile duct and in chronic inflammation, cysts or tumors of the pancreas. It is an invasive examination that uses X-rays to image the bile and pancreas ducts.

Due to the existing risks from radiation, contrast media and the invasive procedure, this method is only carried out if MRCP and ultrasound examinations have not produced any results. Minor surgical procedures can also be undertaken during an ERCP if necessary. This applies to the removal of tissue samples, the widening of the mouth of the duct system, the expansion or bridging of bottlenecks with stents . The procedure of an endoscopic retrograde cholangiopancreatography is similar to a gastroscopy . An endoscope attached to a tube is inserted through the mouth into the duodenum , past the stomach .

There, contrast medium is injected into the father’s papilla against the outflow direction of the bile and the pancreatic secretions (retrograde) and a probe is pulled out of the endoscope. The tube is then inserted into the bile or pancreas ducts via the papilla of the father. The Vater papilla represents the joint exit of the bile and pancreas ducts. At the end of the device there is a light source and a camera. This area can be made visible. The probe ( catheter ) uses X-rays to record the inside of the bile and pancreas ducts and can thus detect stones, narrowings or tumors.

Minor interventions can also be performed if necessary. It can happen that the father’s papilla is too narrow and thus causes a bile drainage congestion. The opening of the papilla can be widened using the endoscope. To do this, it is cut open using a special catheter with an electrically moved wire. If the ducts narrow due to inflammation or tumors, so-called stents made of plastic or metal tubes are often placed to ensure the drainage of bile and pancreatic secretions again. The bile duct can also be examined with a sonographically working probe. This method is called intraductal ultrasound. Gallstones that are close to the bile outlet can also be removed with the endoscope.

The main purpose of ERCP is to diagnose gallstones, cholangiocarcinoma, inflammation of the bile ducts, pancreatic carcinoma and unexplained bile flow disorders. The advantage of endoscopic retrograde cholangiopancreatography is the detection of changes in the bile and pancreas ducts without the need for open surgery. Therefore, a purely diagnostic ERCP can also be performed on an outpatient basis.

Risks, side effects & dangers

Endoscopic retrograde cholangiopancreatography recognizes undiscovered changes in the area of ​​the bile duct and pancreatic duct very well. However, like any invasive procedure, it also carries certain risks. The examination is carried out under short-term anesthesia. As with any anesthetic , the usual anesthetic risks can occur.

In advance, it must be clarified with the patient whether there are any allergies to certain anesthetics and contrast media. The contrast agent may irritate the bile ducts and pancreas. Therefore, in rare cases, pancreatitis can develop. During the procedure, injuries to the larynx , esophagus or gastrointestinal wall with associated bleeding can also occurappear. The risks of X-ray radiation must also be considered. This method should therefore only be carried out if there is no other possibility of a meaningful diagnosis. This procedure is not recommended for pregnant women in particular, because the unborn child is at risk from the effects of X-ray radiation.

Prior to the procedure, it is important that the patient is informed about the risks. Important questions about allergies, previous illnesses or taking medication should also be clarified in this conversation. Drugs that thin the blood can increase the risk of bleeding during this procedure. Therefore, it must be clarified with the doctor in which context the examination can still be carried out. The risk of bleeding may not be as high, or there may be an opportunity to temporarily stop taking blood thinners . In order for the examination to be successful, it is also important that there are no food residues in the digestive tractare located. Therefore, before the ERCP, the patients should urgently comply with the doctor’s instructions for a food fast of at least six hours.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.