Modern Biliary and Pancreatic Diagnostic Procedure

ERCP (Endoscopic Retrograde Cholangiopancreatography) is a medical procedure
that is primarily used to treat certain conditions of the biliary or pancreatic ductal systems
it is also very useful to diagnose and treat some other various conditions. It can be used to
diagnose and remove gallstones, treat inflammatory strictures, leak, and cancer or take
samples of tissue for analysis. The technique combines the uses of an endoscope and X-
rays to look at the bile duct and the pancreatic duct.

The endoscope is a thin, flexible camera that has fibre-optic channels. This is passed
through the mouth, into the oesophagus, down into the stomach and into the duodenum.
The fibre-optic channels allow light to shine down so that the doctor can see the inside of
the stomach and duodenum and inject dyes into the biliary ducts and pancreas so that
they can be seen on X-rays.

The dye is injected into the bile and pancreatic duct through the papilla back up via a
plastic tube in a side channel of the endoscope. The dye blocks the X-rays in the ducts
and makes the ducts show up clearly in the X-ray pictures. Without the retrograde
injection, these ducts won’t show up clearly on ordinary X-ray pictures. Then X-ray
pictures are taken. These X-ray pictures of the bile duct and pancreatic duct is called
Cholangiopancreatography.

There is no strict rule as to the arrangement and the way it is performed. This varies from
hospital to hospital. But patient must get instruction from their physician before
undergoing the ERCP. Such instructions usually include the need to stop using certain
medication before the procedure and not to eat for several hours before the procedure.

Usually, sedative is used. This is injected into a one of the veins at the back of your hand.
The sedative is to make the one to undergo the procedure drowsy and not to make him
sleep so that he can be relaxed. Then the patient is asked to swallow the first part of the
thin endoscope while lying on his side, while the doctor gently pushes it down his throat
into his stomach and duodenum. At the other part of the endoscope, an eye piece or a
monitor is connected to be able to see the inside part. There is a side channel in the
endoscope through which tubes and other instruments can be passed down so that the
doctor is able to do some other things as the case may require. Air is passed down one of
the channels into the stomach and duodenum to make the more visible.

When the procedure is finished, the endoscope is gently pulled out. And it usually takes
between thirty minutes and over an hour. Patients would need to rest for some time after
the procedure before taking their leave to go home. This is to allow the effect of the
sedative to wear off; and it is advisable that someone accompany them for the next
twenty-four hours. They are not to drive or drink alcohol within that period. This is in a
case whereby the ERCP was carried out just to obtain X-ray pictures. But in a case where
it was done to remove gallstone, the person may need to stay in the hospital for a few
days.

Are there any risks involved at all? Yes. Some of the risks include pancreatitis, low blood
pressure as a result of over sedation, gut perforation, damage to bile duct and the risk of
developing chest infection