Ercp Procedure and Uses

How Is the ERCP Procedure Performed and In Which Conditions Is It Used?

ERCP (endoscopic retrograde cholangiopancreatography) is an advanced endoscopic procedure used in the diagnosis and treatment of diseases of the bile ducts and pancreatic ducts. It should be performed in the operating room by a specialist team using special equipment.

The ERCP procedure makes it possible to visualize the bile ducts and pancreatic duct system. In this way, bile stones and strictures can be detected and treated.

At Daviva Health Group, ERCP (endoscopic retrograde cholangiopancreatography) procedures are performed by experienced gastroenterology specialists using advanced technological devices.

How is the ERCP procedure performed? Click for detailed information about bile duct stones, stent placement, and pancreatic duct treatment.

What Is ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is an interventional gastroenterology procedure used to diagnose and treat pathological conditions of the gallbladder, bile ducts, and pancreatic ducts.

Endoscopic retrograde cholangiopancreatography is used to investigate the causes of abnormal flow of bile and pancreatic fluid into the intestines and to relieve this obstruction. The procedure begins with endoscopy of the esophagus, stomach, and duodenum. Then contrast material is injected into the openings of the bile duct and pancreatic duct. In this way, the duct structures can be visualized with X-ray imaging.

During ERCP, treatments such as widening the opening of the bile duct to remove bile duct stones or placing a stent to relieve narrowing of the bile duct or pancreatic duct can also be performed. Stents are small plastic tubes that keep the duct walls open and allow fluids to drain easily.

Because this method allows direct imaging through the administration of contrast material, it is one of the most accurate and sensitive methods for examining diseases affecting the bile and pancreatic ducts. The radiological images obtained are of higher quality and more detailed than those obtained with other tests.

Which Diseases Is ERCP Performed For?

ERCP is an interventional gastroenterology procedure used in the diagnosis and evaluation of bile duct strictures, bile duct strictures, bile duct stones, pancreatic duct obstructions, jaundice, and chronic pancreatitis.

It is one of the most effective methods, especially for removing bile duct stones without surgery. During ERCP, the gastroenterology specialist can remove bile duct stones from the bile ducts in the area called the Vater papilla (duodenal papilla), near where the bile duct opens into the small intestine.

If a tumor is suspected, tissue samples (biopsies) can be taken endoscopically for diagnosis. It is used in the treatment of bile duct obstruction caused by tumors such as pancreatic cancer.

How Is ERCP Performed?

The ERCP procedure is usually performed on an empty stomach and under sedation (light anesthesia). The procedure takes 30–60 minutes on average. ERCP is performed endoscopically, similar to gastroscopy, and allows both endoscopic visualization and X-ray (X-ray) assessment of the bile ducts and pancreatic ducts. The special endoscope used has a light source and a camera at its tip (duodenoscope). The images obtained are projected onto a monitor for detailed evaluation.

The specialist gastroenterologist advances the endoscope through the mouth and stomach into the duodenum. The gallbladder and pancreatic ducts open into the intestine in this region. This common opening point is called the Vater papilla and is the central point of the procedure during ERCP.

When the endoscope reaches this area, a thin catheter passed through the device is inserted into the bile duct via the papilla. If necessary, access can also be made to the pancreatic duct. Then contrast material is injected into the bile and pancreatic ducts and X-ray (X-ray) images are taken.

With this imaging, bile duct stones, bile duct strictures, pancreatic duct obstructions, and tumors can be detected. The most important advantage of ERCP is that it offers both diagnostic and therapeutic options. If necessary, therapeutic procedures such as removing bile duct stones, placing stents, or relieving duct strictures can be performed in the same session.

What Treatments Are Performed With ERCP?

The following procedures can be performed during ERCP:

• Papillo-sphincterotomy (opening of the bile and pancreatic ducts): Opening of the bile and pancreatic ducts in the duodenum is performed by cutting the Vater papilla and the sphincter of Oddi with a special type of electrocautery. This procedure is called papillo-sphincterotomy and is especially used in the treatment of bile duct obstruction.
• Removal of bile duct and pancreatic stones: With ERCP, stones can be removed from the bile ducts or pancreatic duct using special endoscopic equipment. This method is a minimally invasive alternative to surgery in the treatment of gallstones.
• Nasobiliary / pancreatic drainage: Placement of a small plastic tube through the nose into the bile or pancreatic ducts allows adequate drainage for 24–48 hours after the procedure. This application is especially preferred when there is a risk of bile duct infection (cholangitis).
• Widening of duct strictures (Endoscopic dilation / plasty): Narrowing in the bile or pancreatic ducts can be widened with a balloon or special equipment. This procedure is used in the treatment of bile duct stricture.
• Stent (endoprosthesis) placement: The placement of a small plastic tube (removable) or a metal mesh prosthesis (non-removable) into the narrow sections of the bile or pancreatic ducts is called endoprosthesis implantation. Placing a bile duct stent with ERCP relieves obstruction in the ducts.
• Ampullectomy (removal of ampullary tumors): Tumors at the opening point of the bile and pancreatic ducts into the duodenum can be removed endoscopically with the ERCP method.
• Drainage of pancreatic cysts: Pancreatic cysts can be emptied by placing an endoprosthesis, allowing controlled drainage of fluid accumulation.

Preparation Before ERCP

Food and drink should be stopped 8 hours before the procedure. Food residue limits the field of view, jeopardizing the diagnostic reliability of the procedure, and may facilitate aspiration of food residue into the airway in case of vomiting.

If you are using medications such as blood thinners, this should be reported to the doctor before the procedure.

The necessary blood tests should be performed.

The ERCP procedure is generally performed under light sedation. If deep sedation is preferred, an anesthesiologist will need to be present: the patient will be evaluated for anesthesia and will need to sign a special and separate consent form recommended by the anesthesiologist.

Recovery After ERCP

After ERCP, the patient is usually discharged the same day or the next day. Having a companion with the patient is recommended.

Food or drink should not be consumed until the numbness in the throat has worn off and the patient can swallow properly after the procedure.

Do not drive or go to work for 24 hours.

Gas, bloating, and nausea may be felt

There may be mild throat pain, dry mouth, hoarseness, or irritation.

If bile duct stones were removed or a stent was placed, an overnight hospital stay may be required.

In the days following ERCP, it is helpful for the patient to monitor the color of their stool; in case of bleeding, the stool may be dark-colored and foul-smelling.

Nutrition after ERCP;

You should not consume anything for 6 to 8 hours after the examination. Nutrition should begin with liquid-based foods. Later, a light diet plan is adopted. Fatty, spicy, and heavy foods should be avoided.

ERCP Risks and Possible Complications

ERCP may cause the following side effects:

• Post-ERCP pancreatitis (inflammation of the pancreas) is the most common complication.
• Bleeding (hemorrhage)
• Infection
• In rare cases, perforation of the esophagus, stomach, duodenum, bile duct, or pancreatic duct

For ERCP to be performed comfortably and safely, it is important that it be done in fully equipped centers by doctors specialized in this field.

What Is the Difference Between ERCP and MRCP?

Magnetic resonance cholangiopancreatography (MRCP) is a non-surgical diagnostic method that does not require X-rays and is used to examine the pancreas and bile ducts; ultrasound or magnetic resonance methods are used.

Endoscopic Retrograde Cholangiopancreatography (ERCP) is an advanced endoscopic procedure used in the diagnosis and treatment of diseases affecting the bile ducts and pancreatic duct using X-rays.

Frequently Asked Questions About ERCP

What Is the Risk of Pancreatitis After ERCP?

Post-ERCP pancreatitis is the best-known complication of the procedure. It is a temporary inflammation of the pancreas after the procedure. It usually has a mild course and improves with supportive treatment.

How Many Minutes Does ERCP Take?

ERCP usually takes 30 to 60 minutes, after which you remain in the recovery room for 1 to 2 hours. ERCP is usually performed as a day procedure in the hospital's Gastroenterology Department.

Is ERCP a Painful Procedure?

It is an advanced endoscopic procedure performed under sedation. After the procedure, throat irritation and mild abdominal pain may be seen.

Is ERCP Surgery?

No, it is not surgery. ERCP (Endoscopic Retrograde Cholangiopancreatography) is an advanced endoscopic method used in the diagnosis and treatment of diseases of the bile ducts and pancreatic duct.

Is ERCP Dangerous?

ERCP is a safe, non-surgical interventional gastroenterology procedure. As with any medical procedure, it carries risks.

How Many Days Are Spent in the Hospital After ERCP?

After the procedure, the patient is usually discharged the same day. If complications develop, the hospital stay may be extended.

If you have complaints of bile duct stones, pancreatic duct obstruction, or jaundice, you can contact our specialist gastroenterology team to make an appointment.