Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography (ERCP) is a endoscopic procedure which along with fluoroscopy is used to treat Biliary and pancreatic ductal diseases.
It is mainly therapeutic procedure.
Indication
Obstructive jaundice due to
- Bile duct stone (Choledocholithiasis)
- Benign Biliary stricture due to passage of stone or post surgery
- Malignant Biliary stricture
- Bile leak post surgery
Pancreatic Diseases
1. Pancreatic leak in acute pancreatitis
2. Chronic pancreatitis.
Procedure
The procedure is done under Anesthesia in prone position. Side Viewing endoscope is inserted through the mouth, down the esophagus, into the stomach, through the pylorus into the duodenum where the ampulla of Vater is seen. A sphincterotome is inserted through the ampulla, and contrast dye is injected into the bile ducts and/or pancreatic duct. Fluoroscopy is used to look for stones and stricture. Post contrast injection wide biliary sphincterotomy is done. Post sphincterotomy the stones are removed with help of balloon or basket and stent is placed.
Complications
- Post ERCP Pancreatitis – One of the most frequent complications after ERCP, the incidence of PEP has been estimated at 3.5 to 5%.
- Intestinal perforation is very severe complication post ERCP, but happens rarely mostly in malignancy patients.
- Bleeding is a risk post sphincterotomy and very rarely it can cause delayed bleeding which may require blood transfusion.
- Post ERCP patient is admitted for 1 day and is discharged next day if no complications develop.
Post ERCP :
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