ERCP (Endoscopic Retrograde Cholangio Pancreaticography)


Endoscopic retrograde cholangio-pancreaticography (ERCP) is a completely endoscopic procedure performed through the mouth with a special endoscopy instrument. This procedure is used for diagnosis and treatment of the bile and pancreatic ducts. ERCP is an endoscopic method that is often used to remove stones blocking the bile and pancreatic ducts, to clean the ducts and to treat obstructions that cause jaundice and tumors that may be in these ducts.

In Which Diseases Is ERCP Applied?

ERCP is commonly used to unblock the bile duct and remove gallstones. Over time, stones or bile sludge in the gallbladder can separate from the gallbladder and pass into the bile duct, causing a blockage. This is a serious health problem and requires rapid intervention. Patients usually seek medical help with symptoms such as severe pain in the right upper abdomen, nausea, vomiting and jaundice. If the condition progresses over time and bile duct inflammation is added, a more serious condition called cholangitis occurs. In this case, patients often experience additional symptoms such as chills, chills and fever. Laboratory tests may show increased levels of liver enzymes (AST, ALT, ALP, GGT, bilirubins).

ERCP is also performed for tumors that may cause bile duct obstruction (pancreatic head cancers, biliary tract cancers), repair of bile duct leaks during surgery, and expansion of bile duct stenosis with stents or balloons.

ERCP Application and Advantages

First of all, the reason for the procedure must be fully clarified. After the examination, the patient is diagnosed with the following examinations and imaging methods. The procedure is performed under anesthesia and therefore patients do not feel any pain during the procedure. Before the procedure, the patient is put to sleep by the anesthesiologist and then a special endoscopy tool (duodenoscope) is inserted through the mouth; then the small intestine (duodenum) is reached by passing through the esophagus and stomach respectively. There is a very small hole, the size of a pinhead, through which the bile duct and pancreatic ducts merge and flow into the intestine. Once this is found, the targeted bile duct or pancreatic duct is entered through this hole. X-rays are taken from time to time during the procedure to see which duct has been entered. The mouth of the bile duct is then enlarged through an endoscopic incision. The duct is then entered. If the procedure is for gallstones, a balloon is sent behind the gallstone and the balloon is inflated. The balloon is then withdrawn and the stone in the bile duct is dropped into the intestine. Thus, the bile duct is opened. If the procedure is performed to widen the bile duct or pancreatic duct stenosis, balloon widening or stenting can be applied to this area.

The biggest advantage of ERCP is that a difficult procedure such as removing stones in the bile ducts and opening obstructions can be performed endoscopically. In this way, the patient can regain his/her health without the need for surgery or incision. In other words, the procedure is performed by entering through the mouth and the procedure is terminated.

How long is the hospital stay?

Some patients may have abdominal pain after the procedure. These patients are kept in the hospital overnight for follow-up and control. On the morning of the day after the procedure, blood tests and controls are performed and patients are discharged if no additional treatment is required.

What kind of preparation process should the patient undergo before the procedure?

As in all endoscopic procedures, the patient must fast for at least 8 hours. In addition, some blood thinners should be discontinued in the days before the procedure. All these issues are evaluated on a patient-specific basis.

ERCP is performed under general anesthesia with the anesthesiologist putting the patient to sleep. In this way, the patient does not feel any pain and does not remember the procedure.

Why is a stent inserted during ERCP?

A stent is not placed in every patient during the procedure, but in some cases a stent may be placed. For example, in the presence of a gallstone that has fallen into the bile duct, even if this stone is removed, a stent can be inserted to eliminate the risk of a new stone falling into the duct during the period until the gallbladder surgery. In the presence of large stones in the gallbladder, stenting may also be used when the procedure cannot be completed in a single session. A stent can also be inserted to relieve the compression caused by tumors of the bile duct, liver or pancreatic head. Another reason is bile duct injuries that may occur during gallbladder and liver surgeries. In these cases, a stent can also be placed in the bile duct.

Are there risks associated with the procedure?

The ERCP procedure is much more complicated than routine endoscopic procedures and the risks are higher than other procedures. Possible risks include bleeding, inflammation of the pancreas (pancreatitis) and intestinal perforation. Therefore, it is vital that ERCP is performed by an experienced doctor and in a well-equipped hospital.

What is the process after the procedure?

After the ERCP procedure, the patient usually stays in the hospital overnight and is planned to be discharged the next day if no problems are detected in the tests performed. Since each patient’s diagnosis and the reason for the procedure is different, the hospitalization period may vary. Depending on the disease, antibiotic treatment is usually recommended after discharge. After the procedure, food intake with liquid and fat-free foods is started. In case of complaints such as severe abdominal pain, jaundice, darkening of urine color, a doctor should be consulted. The first follow-up visit after the procedure varies depending on the disease, but is usually scheduled for a few weeks later.