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Endoscopic Retrograde Cholangio Pancreatography ERCP
ERCP is used to investigate and treat conditions of the pancreatic head and bile duct system. It is particularly useful to treat complex gallstone disease where stones have left the gall bladder causing jaundice, cholangitis or pancreatitis.
After a period of dietary restriction usually at home, admission is made to hospital as a day case. A consent form is signed by doctor and patient. An intravenous cannula is inserted and a sedative/ pain-killer administered. A mouth guard is placed to protect the teeth and local anaesthetic sprayed onto the back of the throat. The scope is inserted through the mouth and guided into the duodenum whilst the patient lies on their left side, relaxed and resting or in a light but easily arousable sleep. An endoscopist, nurse and radiographer are required to perform the procedure since it combines the use of endoscopy and x-ray.
The procedure takes about 15 to 45 minutes to complete depending upon the complexity of the case and the results can usually be given and clearly understood within an hour or so of completion. Any biopsies taken will be sent for pathological assessment and results may not be available for several days. Normal diet and activity may be resumed over the next 24 hours although a small amount of abdominal discomfort may remain over this period which usually quickly improves.
A special side viewing scope is used to identify the outlet of the biliary system in the second part of the duodenum. Through the scope a variety of instruments (wires, dilators, baskets and crushing devices) may be passed. The technique is used to take biopsies and identify blockages or narrowings due to stones or tumours. Stones can be removed whole or smashed, strictures (narrowings) can be dilated and stents (metal or plastic tubes) inserted to allow drainage of bile or to let fragments of stones pass.
Complications of the procedure include bleeding (less than 1 in 100 cases), pancreatitis (less than 1 in 100 cases), and duodenal perforation (less than 1 in 1000 cases). Complications may require hospital admission, observation and/ or emergency surgery.