43262 Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy

Name of the Procedure:

Endoscopic Retrograde Cholangiopancreatography (ERCP) with Sphincterotomy/Papillotomy

Summary

Endoscopic Retrograde Cholangiopancreatography (ERCP) with sphincterotomy/papillotomy is a procedure where a flexible tube with a camera (endoscope) is used to diagnose and treat issues in the bile ducts, pancreatic ducts, and gallbladder. The sphincterotomy or papillotomy part involves making a small cut in the sphincter muscle to allow for better drainage or removal of blockages.

Purpose

Medical Conditions Addressed:

• Bile duct stones
• Pancreatitis
• Bile duct strictures or blockages
• Tumors in the bile duct or pancreas

Goals:

• Remove blockages or stones
• Relieve pain or jaundice
• Obtain tissue samples for biopsy
• Insert stents to keep ducts open

Indications

Symptoms and Conditions:

• Abdominal pain
• Jaundice (yellowing of skin and eyes)
• Abnormal liver function tests
• Bile duct or pancreatic duct obstruction

Patient Criteria:

• Patients with confirmed or suspected bile or pancreatic duct obstructions
• Patients unresponsive to other less invasive treatments

Preparation

Pre-Procedure Instructions:

• Fasting for at least 6-8 hours before the procedure
• Adjustments in medication, especially if taking blood thinners
• Pre-procedure blood tests to evaluate liver function and blood clotting

Procedure Description

1. Sedation: The patient is given sedatives or anesthesia to relax and minimize discomfort.
2. Insertion: An endoscope is inserted through the mouth, down the esophagus, and into the stomach and first part of the small intestine.
3. Contrast Dye Injection: A contrast dye is injected into the bile duct through a small catheter to visualize the ducts on X-rays.
4. Sphincterotomy/Papillotomy: A small cut is made in the sphincter of Oddi to allow for drainage or removal of stones.
5. Completion: Stones or blockages are removed, and if necessary, stents are placed.

Tools and Equipment:

• Endoscope with camera
• Catheters for dye injection
• Surgical tools for cutting and removing blockages

Duration

Typically takes 30 minutes to 1 hour.

Setting

Performed in a hospital or specialized outpatient center with X-ray facilities.

Personnel

• Gastroenterologist or specialist in endoscopic procedures
• Nurses and technicians
• Anesthesiologist for sedation

Risks and Complications

Common Risks:

• Pancreatitis
• Infection
• Bleeding

Rare Complications:

• Perforation of the intestine
• Allergic reaction to the contrast dye

Benefits

• Relief from pain and jaundice
• Improved digestion
• Effective diagnosis and treatment of ductal issues
• Benefits are often immediate after successful removal of blockages

Recovery

Post-Procedure Care:

• Observation for a few hours post-procedure to monitor for complications
• Hydration and gradual reintroduction of foods

Recovery Time:

• Most patients can resume normal activities within a few days
• Follow-up appointments as needed

Alternatives

Other Treatment Options:

• Non-invasive imaging like MRI or CT scans
• Percutaneous transhepatic cholangiography (PTC) for direct ductal examination
• Open surgical options for severe cases

Pros and Cons:

• ERCP Pros: Minimally invasive, immediate treatment
• ERCP Cons: Risks of sedation and specific complications

Patient Experience

During the Procedure:

• Will not feel pain due to sedation but may experience some discomfort

After the Procedure:

• Sore throat, bloating, or mild discomfort is common
• Pain management with prescribed analgesics
• Clear dietary instructions to follow

Comfort measures, care, and guidance will be provided to ensure a smooth recovery process.