Examination of bile and pancreas

ERCP is an acronym that consists of the first letters of “endoscopic retrograde cholangiopancreatography” words. This is a method used for endoscopic and radiologic examination of the intra- and extrahepatic biliary ducts as well as the pancreatic ducts. ERCP is performed for the purpose of diagnosis and treatment if there is any biliary and pancreatic stones, tumors and obstruction, or bile duct injury that may occur after gallbladder surgeries, or when blood tests or ultrasound - tomography imaging results are suggestive of any liver or pancreas disease.


The patient is examined in the endoscopy unit, procedure takes time varying 30 to 90 minutes and is usually followed up overnight in the hospital. The ERCP procedure is performed using a long, thin and curled endoscope (duodenoscope) that has a camera on its tip. After sedation with various drugs during the procedure, the duodenoscope is inserted through the mouth and passed through the esophagus and stomach, and is operated in the first part of the small intestine, called duodenum, in the area opening to the bile and pancreatic ducts. A catheter is advanced through the entry of the bile duct, contrast media is infused and radiological imaging of these canals are obtained. During the procedure, some medications (sedo-analgesia) are administered to prevent pain during ERCP. No difficulty in breathing is experienced because the trachea is out of the area of interest.

Rarely some treatments can take place. These will be explained to you by your doctor before the procedure depending on the condition of your disease.

Processes during ERCP are summarized as follows: 

  • Sphincterotomy: If a stone or any blockage is seen in the biliary tract, or if the physician deems it necessary, the region of the bile duct (papilla) can be expanded.  
  • If there is any stone or sludge in the biliary tracts these are removed through the expanded canal using instruments called balloon or basket. Large and hard stones can be extracted after crushing them using the method of mechanical lithotripsy.
  • Stent implanting: Stents are in the shape of pipe and made of plastic or metal wires and allow bile flowing to intestines through the narrowed biliary ducts. They can also be implanted in the pancreatic duct when necessary.
  • Nasobiliary tube insertion: Sometimes, a plastic tube with one end in the biliary ducts and with one end out of the nose can be inserted. This both makes the bile flow easy and allows controlling by infusing contrast media.

Sphincterotomy (opening the end of the biliary duct by cutting it), extraction stone through the biliary duct and implanting a stent (a small-sized plastic/metal tube) are the the most common procedures.

At the result of not performing an ERCP procedure, conclusions are obtained based on the condition of the disease requiring the procedure. Pictures such as pancreatitis, obstruction jaundice, liver insufficiency, encephalopathy can be observed. Results that require emergency surgery can be encountered.

Alternative Treatments

Even though there is no any alternative method equivalent to the ERCP procedure, radiological imaging methods (CT, MRI, etc.) can be used instead for diagnostic purposes. A stent or cannula can be inserted in the biliary tracts in the liver by entering through the abdominal wall in order to drain bile (percutaneous transhepatic procedures).

Extraction of stones or enlarging narrow sites can also be performed through surgical procedures. However, these procedures are more invasive than ERCP and could left damage.

 


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