This procedure is used to examine the duodenum (top portion of small intestines), papilla of Vater (Structure with nipple-like openings leading to bile ducts and pancreatic duct), bile ducts, pancreatic duct and gallbladder. ERCP uses a duodenoscope, a thin viewing tube, which is passed through the mouth, esophagus, and stomach into the duodenum. Once the papilla of Vater is identified, a catheter is protruded out of the duodenoscope into the bile ducts, injecting them with a special dye. At this time, biopsies may be performed, obstructions may be removed and incisions can be made by inserting a variety of instruments through the duodenoscope.
ERCP is used in the diagnosis and treatment of the following conditions:
In order for this procedure to be effective and timely, it is important that the stomach be emptied before the procedure. Therefore, the patient should not ingest anything after 12 AM the night before the exam. Heart and blood pressure medication should be taken with a glass of water in the morning before the exam. Also, make sure to prepare a driver to take you home after the exam is over. You will not be allowed to drive yourself home.
Before the procedure begins, a mild sedative and pain medications are administered. The physician may also administer an anesthetic to reduce or prevent the gag reflex which may result from inserting the duodenoscope into the esophagus. After these preliminary measure have been completed, the patient lies on his/her left side and the duodenoscope is slowly inserted through the mouth, down the esophagus, into the stomach and finally into the duodenum. There is minimal discomfort to the patient except for the foreign body sensation in the esophagus. This procedure lasts between 15 and 60 mins.
The patient will remain in the recovery room until the sedatives and medication have almost entirely worn off. At that point, the physician may decide to discuss the results of the exam. Afterwards, the driver may take the patient home, where he/she should rest for the remainder of the day. Normal activities can be resumed the following day.
The success rate for this procedure is approximately 75-90%. There are very few complications. This procedure should be a simple out-patient procedure for an experience, well-trained physician. However, complication can arise even under the best circumstances. Complications include: pancreatitis, infection, perforation, drug reactions, bleeding, heart attack, irregular heart beat and depressed breathing--all of which are extremely rare. Hospitalization could be required if complications arise, but surgery is almost never necessary.
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