Endoscopic Retrograde Cholangiopancreaticography
Endoscopic retrograde cholangiopancreaticography (ERCP) is a procedure during which instruments are inserted into the Ampulla of Vater in order to access the biliary or pancreatic duct systems. The Ampulla of Vater is an opening surrounded by a muscular sphincter, which connects the duct draining secretions from the pancreas (pancreatic duct) and the duct draining bile produced in the liver (common bile duct) to the duodenum. This procedure is performed using a different type of scope to that used in gastroscopy – a “side-viewing” scope. The camera on the end of this scope looks out of the side of the tip, not the end. This allows visualization and access to the Ampulla of Vater.
ERCP is used to diagnose many conditions affecting the biliary tract. The benefits of ERCP over MRCP (MRI scan of the pancreatic and biliary duct systems) are that it provides finer details than MRCP and that you can perform therapeutic interventions simultaneously. The down-side is that it is more invasive, and as a result can cause potentially serious complications.
Interventions can be performed in the biliary tract using ERCP, such as:
- Removal of gallstones causing blockage or infection
- Insertion of stents for strictures (benign or cancerous)
- Collection of samples for cytology to diagnose cancers in the biliary tract
- SpyglassTM can be used via the side-viewing scope (See SpyglassTM)
Complications
ERCP is a procedure in which serious complications can occur. Because of this, there should be a clear indication for the procedure and the benefits of doing should outweigh the risks.
- Sedation-related complications e.g. over-sedation with suppression of breathing. An antidote will be given in this situation and the procedure will be abandoned.
- Bleeding - Because the Ampulla of Vater is cut during the procedure, there is the potential for significant bleeding. If this occurs, it can usually be controlled endoscopically. If the bleeding is severe, it may require a blood transfusion. This complication is rare.
- Perforation - This is when a hole is made in either the duodenum (by the scope) or the biliary tract (by instrumentation). Both situations are serious and need to be managed aggressively. An emergency operation may be required to close the hole. This complication is rare.
- Pancreatitis - Inflammation of the pancreas can occur after ERCP. Steps are usually taken to reduce the risk of this complication, but cannot always prevent it from occurring. Post-ERCP pancreatitis varies in severity, from mild to very severe.
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