ERCP (Endoscopic Retrograde Cholangiopancreatography ) is a procedure to examine and treat disorders of the pancreas and bile ducts. This procedure is a combination of an endoscopic examination and X-rays equipped with contrast dye.
ERCP (MRCP) is carried out with the help of an ERCP scope, which is a tool in the form of a thin tube equipped with a camera and light at the end. This tool will be inserted through the patient's mouth, through the esophagus, then into the stomach and duodenum, to the end of the bile duct and pancreatic duct, which allows the doctor to take pictures and see the condition of the bile duct and pancreas in more detail. In addition, ERCP can also provide important information that cannot be obtained from other diagnostic examinations.
ERCP is used to diagnose various disorders that occur in the bile and pancreatic ducts, such as:
- Acute pancreatitis and chronic pancreatitis
- Tumor or cancer in the pancreas
- Tumor or cancer of the bile ducts
- Trauma to the bile ducts and pancreas
- Bile duct stones or narrowing of the bile ducts
- Cholecystitis or inflammation of the bile ducts
There are several conditions that cause patients to not be able to undergo the ERCP procedure, namely:
- Currently in pregnancy
- Have had surgery on the digestive tract which caused the bile duct to close
- Suffering from abnormalities in the esophagus or digestive tract that make the ERCP procedure difficult
- Have recently undergone a procedure that uses barium contrast, because the barium content in the intestine can interfere with the ERCP procedure
Before carrying out the ERCP procedure, the doctor will explain to the patient about the stages of the procedure that will be followed, the objectives, and complications that may occur. After that, the doctor will give the patient a form to sign, stating that the patient understands and agrees to undergo the procedure.
The ERCP procedure generally lasts 1-2 hours, depending on the patient's condition and the purpose of the ERCP itself. The following are the stages that the doctor will carry out in the ERCP procedure:
- Ask the patient to remove jewelry and other accessories that could affect the procedure, and change into the hospital clothes provided
- Ask the patient to lie on the examination table or bed with the body tilted to the left or on his stomach
- Administer a sedative through an IV and spray the anesthetic into the throat, so that the patient does not feel anything when the endoscope is inserted
- Wearing a mouth guard to keep the patient's mouth open during ERCP
- Insert the endoscope into the patient's mouth, then push it into the stomach and upper part of the duodenum
- Pumping air into the stomach and duodenum through the endoscope to get a clearer picture of the organs
- Insert the catheter channel through the endoscope, then push it up to the bile duct and pancreatic duct
- Inject a contrast agent through the catheter, so that the bile ducts and pancreatic ducts can be seen more clearly
- Take a series of photos with X-ray (fluoroscopy) then check for signs of narrowing or blockage in the bile ducts and pancreatic ducts
During ERCP, the patient is under anesthesia.
After the ERCP procedure is completed, the patient is required to recover for 1-2 hours until the effects of the sedative and anesthetic wear off. The doctor will also monitor the patient's condition during the recovery process.
The doctor will discuss the results of the ERCP examination with the patient after the patient has fully recovered. If the doctor performs a biopsy during ERCP, the results of the examination will only be known several days later. If the ERCP results show that the patient requires medical treatment, the doctor will determine the next course of treatment.
Article written by dr. Muhammad Yamin Lubis, Sp.PD-KGEH, FINASIM (Internal Medicine Specialist - Gastro Entero Hepatology Consultant at EMC Sentul Hospital).