Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is it?

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure that combines the use of a flexible, lighted scope (endoscope) with X-ray pictures to examine the tubes that drain the liver, gallbladder, and pancreas. ERCP can treat certain problems identified during the procedure. If an abnormal growth is seen, an instrument can be inserted through the endoscope to obtain a sample of the tissue for further testing (biopsy). If a gallstone is present in the common bile duct, the doctor can sometimes remove the stone with instruments inserted through the endoscope. A narrowed bile duct can be opened by inserting a small wire-mesh or plastic tube (called a stent) through the endoscope and into the duct.

Why is it required?

Stones can form in the gallbladder, an organ under the liver that collects and stores bile for digestion. If the stones travel into the common bile duct, the tube connecting the liver to the intestine, they can become stuck and block the flow of bile. This is called choledocholithiasis. Blockage of the bile duct can also occur for other reasons and result in jaundice, such as by tumours of the pancreas, duodenum or bile duct itself, or from scarring of the bile duct caused by some form of previous injury.

What are the symptoms?

The bile will then back up into the liver, which can cause a person to become jaundice, or appear yellow especially in the eyes. The patient may have intermittent pain in the upper right side of the belly prior to noticing the yellow color (jaundice). The patient may also notice pale coloured stool.

How is it Diagnosed?

The diagnosis of choledocholithiasis begins with blood work, after a complete history and physical, to determine if the about of bile in the blood is increased and if there is evidence of damage to the liver. An ultrasound is often performed, which may show enlargement of the common bile duct, stones in the common bile duct, or stones in the gallbladder.

Treatment Options

The next step for diagnosis and for treatment is an endoscopic retrograde cholangiopancreatography (ERCP). A camera is passed through the mouth into the intestine to the opening of the common bile duct. Dye is injected into the duct and any blockage or stone is identified. If a stone is present, balloons or baskes can be used to remove the stone from the duct, thereby avoiding open surgery.

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