Endoscopic retrograde cholangiopancreatography or ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) via endoscopic biliary and pancreatic catheterization is a procedure that helps determining the origin of your disorder if other examinations have not been able to establish the diagnosis. It also allows for endoscopic treatment of your disease.

This procedure may include the removal of stones, drainage of the pancreas and/or bile ducts, placement of a prosthesis, etc.

ERCP is a challenging examination that can be compared to an endoscopic surgical procedure. The duration of the examination varies according to the indication (for example, it takes longer to remove 10 stones from a bile duct than one stone) and according to the technical difficulties encountered. It takes a minimum of 20 minutes and the examination can sometimes last for 2 hours.

To this must be added the time of installation in the examination room and the time of anesthesia and recovery. It is usual to stay in the recovery room for 1 to 3 hours for monitoring purposes by the Department of anesthesiology, as after a surgery.

In order for the examination to take place under good conditions, the stomach must be empty. You should not eat, drink, or smoke for 6 hours before the examination. Always inform your doctor of any allergies or medications you are taking. Before the examination, false teeth and glasses must be removed.

The bile and pancreatic ducts open into the initial part of the small intestine (duodenum) through an opening called the papilla. The examination uses an endoscope that is slid through the mouth into the duodenum. It takes place in a radiology room. Diagnostic catheterization consists of introducing a catheter (small tube) into the papilla to inject a contrast medium into the bile and/or pancreatic ducts. X-rays are then taken. Following these x-rays and during the same session, a treatment can be performed.

The first phase of treatment usually consists of opening the orifice of the bile duct (choledochus) with an electric scalpel (endoscopic sphincterotomy). Subsequently, the stones can be removed with a basket or balloon, possibly by breaking them up first. In case of a stricture, it can be dilated with an inflatable balloon or a "bougie". A permanent or temporary drain (prosthesis) can also be placed through this narrowing.

Sometimes, it is necessary to repeat the endoscopy to complete the treatment after having discussed the therapeutic possibilities.

Between each patient and according to the recommendations in force, the endoscope is disinfected and the accessories used are sterilized or discarded (single-use material) to prevent possible transmission of infections.

For better tolerance of the examination, a general anesthesia is often performed. It is the responsibility of the anesthesiologist to answer your questions about his or her specialty.

As the examination is performed under general anesthesia, you will not feel anything during the examination. When you wake up, you may feel the side effects of the anesthesia (drowsiness, nausea, fatigue) and the inconveniences of the endoscopy (discomfort in the throat or in the mouth and lips, bloating, gas emissions, diarrhea).

Pain due to bloating and manipulation of the pancreas and bile ducts is common in the 12 hours following the examination. Painkillers will be administered regularly and at your request.

Sometimes a temporary drainage of the pancreas or bile ducts is implemented for 1 to 7 days via a drain that goes through the nose. This drain may cause discomfort in the nose and throat. Feeding is sometimes allowed with the drain in place.

You will not be allowed to eat on the day of the examination. Feeding will be resumed the next day unless there is a complication or other examinations are required.

Any medical procedure, exploration, or intervention on the human body, even if carried out in competent and safe conditions in accordance with current medical data and regulations, involves a risk of complications.

Complications of diagnostic ERCP are rare when only X-rays are performed. These include acute inflammation of the pancreas (acute pancreatitis) or infection of the bile ducts or gallbladder. Antibiotics are routinely given before ERCP and a few hours after the examination to minimize this risk.

Complications of therapeutic ERCP (endoscopic sphincterotomy and associated treatments) are more common: acute pancreatitis, infection of the bile ducts or gallbladder, perforation of the digestive wall, or digestive hemorrhage. The frequency of each of these complications is about 1%.

Other complications are exceptional, such as cardiovascular or respiratory problems. These complications may be favored by your medical and surgical history or by the use of certain medications.

All these complications may require a delay in refeeding, a longer hospital stay, and the need for a repeat endoscopy or surgery. Hemorrhage may necessitate blood or blood derivative transfusions.

Complications most often appear during the endoscopy but can also occur a few days after (abdominal or thoracic pain, fever, chills, etc.). In this case, it is very important to contact the doctor and/or the anesthetist who took care of you immediately at the following telephone number: 02/764 28 23 or 02/764 11 11 and ask for the person call 4 28 39. If you are unsuccessful in contacting them, it is imperative that you contact your treating physician as soon as possible.

Ultrasound, CT scan and sometimes MRI are usually performed before ERCP. The latter is requested to clarify these examinations. MRI can allow a good visualization of the liver and pancreas ducts and, if they are normal, avoid ERCP. ERCP is the only diagnostic procedure that allows for simultaneous treatment (stone removal, prosthesis). Surgical treatment can be an alternative to endoscopic treatment but requires a longer hospital stay and is associated with higher risks, especially in elderly subjects.

If the examination your doctor has suggested is not done, it can have harmful consequences for your health. A bile duct stone, a benign disease, left in place can lead to a severe infection, sometimes fatal.

The doctor is at your disposal for any further information.