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Endoscopic Retrograde Cholangiopancreatography (ERCP)

General Surgery

Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and X-ray technology. It involves inserting an endoscope orally, passing through the oesophagus and stomach to reach the second part of the duodenum. A catheter is then used to inject a contrast medium into the bile and pancreatic ducts to diagnose and treat blockages in the pancreas or bile duct.

Technology Application

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a therapeutic procedure that combines endoscopy and X-ray technology, primarily used for diagnosing and treating issues related to the gallbladder, bile ducts, and pancreas.Through an endoscope, doctors can visualize the interior of the stomach and duodenum and inject contrast dye into the ducts of the gallbladder and pancreas to be displayed on X-ray images.

Using fluoroscopy, doctors can obtain continuous X-ray images to assist in:

Guiding catheters through the patient's ducts
Observing the condition of the patient's bile and pancreatic ducts, and gallbladder
Removing stones and other blockages
Placing stent devices in the ducts to maintain patency

Medical Use

Diagnosis

Doctors use ERCP as a diagnostic tool for the following conditions:

Obstructive jaundice - possibly caused by various reasons
Gallstones causing bile duct dilation, as seen in ultrasound examinations
Uncertain bile duct narrowing and suspected bile duct tumours
Suspected traumatic or iatrogenic injury to the bile duct
Sphincter of Oddi Dysfunction (SOD)

Treatment

Doctors use ERCP as a therapeutic tool for the following conditions:

Sphincter of Oddi sphincterotomy
Extraction of gallstones or other fragments in the bile duct
Placement of stents into the common bile duct or pancreatic duct through the major duodenal papilla and ampulla of Vater
Dilation of strictures (e.g., primary sclerosing cholangitis, anastomotic strictures post-liver transplantation)

Procedure

Here are the steps of ERCP:

Preparation: Before undergoing ERCP, the patient needs to provide a medical history, including allergies and medication use. The doctor may recommend fasting for a period before the procedure.
Anesthesia and Sedation: The patient typically receives local throat anaesthesia during ERCP to reduce discomfort. In some cases, the doctor may administer intravenous sedatives to promote relaxation.
Insertion of Endoscope: The doctor inserts a flexible tube-like instrument called an endoscope through the patient's mouth, passing through the oesophagus and stomach, ultimately reaching the second part of the duodenum. The endoscope has a light source and a lens, allowing the doctor to view internal structures.
Injection of Contrast Agent: The doctor injects a contrast agent through the catheter, ensuring better visibility under X-ray to examine the condition of the bile ducts and pancreas.
X-ray Examination: Simultaneously with the insertion of the endoscope, X-ray images are taken continuously, providing dynamic visualization of the biliary and pancreatic ducts. It helps guide the catheter through the patient's ducts and assess the condition of the bile and pancreatic ducts.
Treatment Steps: If issues are identified during the examination, the doctor may perform therapeutic procedures. This could include dilation of ducts, removal of stones, insertion of stents, and other interventions.
Conclusion and Observation: After the examination and treatment, the endoscope is removed from the patient's oral cavity. The patient is observed for a period to ensure no apparent complications.