What is a ERCP?
ERCP stands for endoscopic retrograde cholangio-pancreatography. An ERCP is an endoscopy (a flexible camera) examination in which a trained doctor navigates a special side-viewing endoscope (duodenoscope) through the mouth, oesophagus (gullet), and stomach, to the opening of the bile ducts in the duodenum (small bowel). A mouthguard is placed in the mouth between the teeth (see picture). Contrast (a fluid that shows up on x-rays) is injected into the bile ducts, using x-ray screening, the outline of the bile ducts is clear to see, treatments then can be performed as required.
Video clip shows a side viewing duodenoscope with the bridge, a lever that allows the instruments angle of approach to be altered.
What are the benefits?
The main benefit of an ERCP being performed is to treat problems within the bile duct. An ERCP is almost exclusively performed to deliver treatment. Having blocked bile ducts usually makes you jaundiced, and can lead to life threatening (biliary) infection, when severe this is known as sepsis. Treatments include, cutting the opening of the bile ducts (sphincterotomy), removing gallstones lodged in the bile duct, and placing a stent (a plastic or metal tube) across a narrowing in the ducts caused by gallstones, or a stricture (a narrowing due to; cancer, benign scar tissue, or inflammation).
What are the risks?
For the majority of patients, an ERCP is usually a safe examination and thankfully serious complications are rare. However, as the risks are higher than other endoscopy examinations, you’re Doctor and you have to weigh up the risks and benefits before having the procedure. It is important to note that the sedation can also have risks as well as the procedure itself.
Mild discomfort in the abdomen and a sore throat, which may last up to a few days.
Mild inflammation of the pancreas (pancreatitis). This can happen in approximately 5 in 100 procedures, with severe pancreatitis in 1-2 in 100 procedures.
Bleeding (immediate or delayed) following a sphincterotomy (1 in 100 procedures).
Inability to gain access to the bile ducts, this may require further urgent treatment to deal with jaundice.
Infection in the bile duct can occur (cholangitis) which can be dangerous.
Perforation (a hole in the wall) of the oesophagus, stomach, and duodenum, which may require an operation to repair the damage (1 in 1000 procedures).
What are the alternatives?
You are under no obligation to have this procedure. Any suitable alternatives should have been discussed in advance with your clinician.
You are under no obligation to have this procedure. As an ERCP is almost exclusively performed to deliver treatment, the alternative approach is to deliver treatment by accessing the bile ducts through the skin and the liver, this is known as an external biliary drain and can incorporate a stent insertion and is performed by a Consultant Radiologist. This is at a higher risk of bleeding then an ERCP. Sometimes it is necessary to perform an external biliary drain is an ERCP has been unsuccessful in delivering its intended treatment.
The decision is yours as to whether to have an ERCP or not. However, without an ERCP your doctor may not be able to find a cause of your symptoms and it may be difficult to plan any further treatment.