Endoscopic retrograde cholangiopancreatography (ERCP); with destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy)
CPT4 code
Name of the Procedure:
Endoscopic Retrograde Cholangiopancreatography (ERCP) with Destruction of Calculi
Common Name: ERCP with stone removal
Technical Terms: Endoscopic retrograde cholangiopancreatography, lithotripsy, mechanical, electrohydraulic
Summary
ERCP with destruction of calculi is a medical procedure used to examine the bile ducts and pancreas using an endoscope—a flexible tube with a light and camera. During the procedure, any gallstones or pancreatic stones found are broken down and removed using specialized techniques such as mechanical crushing, electrohydraulic or other methods.
Purpose
Medical Condition: This procedure addresses blockages in the bile ducts or pancreas caused by stones (calculi).
Goals: The primary goal is to remove the stones, alleviate the blockage, and restore normal bile and pancreatic fluid flow, thereby reducing symptoms like pain, jaundice, and inflammation.
Indications
Symptoms: Severe abdominal pain, jaundice, pancreatitis, cholangitis, and abnormal liver function tests.
Conditions: Presence of gallstones, pancreatic stones, bile duct stones, and biliary strictures. Patients often have confirmed imaging showing stones causing blockages.
Preparation
Pre-procedure Instructions:
- Patients are usually required to fast for at least 6-8 hours before the procedure.
- Patients may need to adjust medications, especially blood thinners, under physician guidance. Diagnostic Tests:
- Blood tests, ultrasound, or MRI scans of the abdomen may be required to identify the location and size of the stones.
Procedure Description
Steps Involved:
- Administration of sedation or anesthesia to ensure patient comfort.
- Insertion of an endoscope through the mouth, esophagus, and stomach into the small intestine.
- Injection of a dye into the bile ducts and pancreas for better visibility using X-rays.
- Identification of stones using the camera.
- Removal or destruction of stones using methods such as mechanical crushing or electrohydraulic lithotripsy. Tools and Equipment: Endoscope, fluoroscopy machine, dilation balloons, baskets, and lithotripsy devices.
Duration
The procedure typically lasts between 30 minutes to 2 hours, depending on the complexity and number of stones.
Setting
ERCP is performed in a hospital, mostly in a specialized endoscopy suite or an operating room.
Personnel
Healthcare Professionals Involved:
- Gastroenterologist or surgeon trained in ERCP
- Anesthesiologist or nurse anesthetist for sedation
- Nursing staff to assist during the procedure
Risks and Complications
Common Risks: Mild sore throat, abdominal discomfort, nausea.
Rare Complications: Pancreatitis, infection, perforation of the intestines, bleeding. Management may involve antibiotics, hospitalization, or additional surgeries.
Benefits
Expected Benefits: Relief from pain, resolution of jaundice, prevention of complications like pancreatitis or cholangitis.
Time to Realization: Most patients notice improvement within a few days after the procedure.
Recovery
Post-Procedure Care: Patients may need to stay in recovery for a few hours for observation.
Instructions: Avoid heavy meals, follow a soft diet, and take prescribed medications.
Recovery Time: Most patients can return to normal activities within a week.
Restrictions and Follow-up: Limited physical activity for 24-48 hours, follow-up appointments to monitor recovery.
Alternatives
Other Options: Medication to dissolve stones, extracorporeal shock wave lithotripsy (ESWL), percutaneous transhepatic cholangiography (PTC), or surgery.
Pros and Cons: ERCP is less invasive compared to open surgery but may not be effective for all stone sizes and locations. Medications may take longer to work and may not be suitable for all patients.
Patient Experience
During the Procedure: Patients are sedated or under anesthesia, so they generally do not feel pain but might experience a sensation of something in their throat.
After the Procedure: Patients might feel drowsy from sedation, have a mild sore throat, and experience some abdominal discomfort which should subside in a day or two. Pain management includes prescribed painkillers and ensuring comfort.