Endoscopic, Retrograde Cholangio Pancreatography/ERCP

Dr. Yanto Budiman, Sp.Rad., M.Kes

If a gallstone is found, steps may be taken to remove it. If the duct has
become narrowed, an incision can be made using electrocautery
(electrical heat) to relieve the blockage, it is possible to widen
narrowed ducts and to place small tubing, called stents, The exam
takes from 20 to 40

ERCP
Endoscopic, Retrograde Cholangio Pancreatography
Endoscopic :use of an instrument called an endoscope - a thin, flexible
tube with a tiny video camera and light on the end.
Retrograde :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.
Cholangiopancreaticography :Imaging the bile duct system, and
pancreas.
Indications for imaging
Gallstones, which are trapped in the main bile duct
Blockage of the bile duct
Jaundice
Undiagnosed upper-abdominal pain
Cancer of the bile ducts or pancreas
Pancreatitis
When pancreatitis is caused by gallstones, it is necessary to remove the
gallbladder.
At times, an ERCP (Endoscopic Retrograde Cholangio Pancreatography)
test is recommended. This involves passing a flexible tube through
the mouth and down to the small intestine. A small catheter is then
inserted into the bile duct to see if any stones are present. If so, they
are then removed with the scope.

Side Effects and Risks

A temporary, mild sore throat sometimes occurs after the exam.
Serious risks with ERCP are uncommon. One such risk is excessive
bleeding, especially when electrocautery is used to open a blocked
duct.
In rare instances, a perforation or tear in the intestinal wall can occur.
Inflammation of the pancreas also can develop.
There is also a small risk of an allergic reaction to the dye, which
contains iodine. Rarely, drugs used to relax the ampulla of Vater can
have side effects such as nausea, dry mouth, flushing, urinary
retention, rapid heart rate (sinus or supraventricular tachycardia), or
a drop in blood pressure
Due to the mild sedation, the patient should not drive or operate
machinery for six hours following the exam.
Contrast Media
20 ml non-ionic/low-osmolality 200 mg/ml contrast media

Preparations
Patients should ingest no solids for at least 6-7 hours and no liquids for
at least four hours prior to the procedure.
For some procedures, topical pharyngeal anesthesia alone is sufficient,
especially when the endoscopy is performed with a small diameter
endoscope.
For prolonged examinations, those in children, or in patients with a high
degree of anxiety, rapid onset sedatives and/or analgesics are often
necessary.
Anticholinergics (e.g., atropine) have been given to decrease saliva,
gastric secretions and motility, and reduce the likelihood of
vasovagal reactions; For procedures in which paresis of
gastroduodenal motility is necessary, parenteral glucagon may be
useful

Basic Procedure

The throat is anesthetized with a spray or solution

Magnetic resonance cholangiopancreatography (MRCP)

When compared to ERCP or PTC the accuracy is very similar. MRCP has
a sensitivity and specificity of 91% and 98% respectively for
choledocholithiasis .
Its accuracy for benign and malignant obstruction is 90%.
Does not carry the 5 - 30% failure rate associated with ERCP . It is also
spares the morbidity (1-7%) and mortality (0.2-1%) of ERCP and is
The endoscope is then gently inserted into the upper esophagus. The
twice as cost effective .
patient breathes easily throughout the exam, with gagging rarely
The disadvantage is that it is solely a diagnostic test.
occurring.
A thin tube is inserted through the endoscope to the main bile duct In choledocholithiasis ERCP would be indicated since endobiliary
therapy can also be carried out.
entering the duodenum.
Contrast media is then injected into this bile duct and/or the pancreatic MRCP is not the initial investigation of choice in cholecystitis as
ultrasound is just as accurate and much more cost effectiv
duct and x-ray films are taken.
The patient lies on his or her left side and then turns onto the stomach
to allow complete visualization of the ducts.