Dr. NIVESH SEEHRA

ERCP

ERCP enables the physician to diagnose problems in the gallbladder, bile ducts, and pancreas. The liver is a large organ that makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and also secretes hormones such as insulin.

Applications

ERCP is primarily used as a therapeutic procedure for treatment of diseases of

Bile duct

extraction of bile duct stones by balloon/basket (balloon/basket extraction)
by crushing large bile stones and retrieving them (mechanical lithotripsy)
relieving jaundice due to bile duct narrowing by dilating passage with balloon (balloon dilation)
treatment of bile duct infection (cholangitis) by draining pus by cutting open bile duct opening (biliary sphincterotomy) and placing stents /catheter in bile duct for free drainage of bile into duodenum ( plastic stent/ENBD placement)
stopping leakage of bile in bile duct injuries as a result of trauma and surgery
metallic stent placement for relief of itcing and jaundice in bile duct, pancreatic, gallbladder cancers (metallic stent placement)

Pancreas

relief of pain in chronic pancreatitis
by removal of pancreatic duct stones
dilating the narrowed pancreatic duct
placing of stents to facilitate drainage of infected fluid collection in pancreatitis (Pseudocyst drainage)

How is ERCP performed?

ERCP combines the use of X-rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on X-rays.

For the procedure, you will lie on your left side on an examining table in an X-ray room. You will be given medication to help numb the back of your throat and a sedative to help you relax during the examination. You will swallow the endoscope, and the physician will then guide the scope through your oesophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on X-rays. X-rays are taken as soon as the dye is injected.