43278 Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed

Name of the Procedure:

Endoscopic Retrograde Cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed.

Summary

ERCP is a medical procedure that combines the use of endoscopy and fluoroscopy to diagnose and treat conditions of the bile ducts, pancreatic duct, and gallbladder. This specific variation involves the removal or destruction (ablation) of tumors, polyps, or other lesions.

Purpose

The procedure addresses blockages or abnormal growths in the bile or pancreatic ducts, which can cause severe pain, jaundice, or pancreatitis. The goal is to remove or reduce the growths to alleviate symptoms and improve duct function.

Indications

• Jaundice (yellowing of the skin and eyes)
• Unexplained abdominal pain
• Pancreatitis or inflammation of the pancreas
• Suspicion of bile duct or pancreatic duct tumors
• Bile duct stones that cannot be removed with simpler methods

Preparation

• Fast for 6-8 hours before the procedure.
• Disclose all medications, allergies, and medical conditions to your doctor.
• Adjust or stop certain medications as directed, especially blood thinners.
• Pre-procedure blood tests and imaging studies might be necessary.

Procedure Description

1. An intravenous (IV) line is started for medications and fluids.
2. The patient is sedated or under general anesthesia.
3. An endoscope (a flexible tube with a camera) is inserted through the mouth, down the esophagus, and into the stomach and duodenum.
4. A contrast dye is injected to visualize the bile and pancreatic ducts on X-rays.
5. A small incision is often made at the ampulla of Vater to access the ducts.
6. A guide wire is passed through the endoscope to the target area.
7. The lesion is ablated using specialized tools passed through the endoscope.
8. Pre- and post-dilation of the ducts may be performed to ensure they remain open.

Duration

Typically takes about 1-2 hours, depending on the complexity of the condition.

Setting

Performed in a hospital or specialized endoscopy suite.

Personnel

• Gastroenterologist or endoscopist
• Anesthesiologist or nurse anesthetist
• Endoscopy nurses and technicians

Risks and Complications

• Infection
• Pancreatitis
• Perforation of the gastrointestinal tract
• Bleeding
• Adverse reaction to sedation or contrast dye
• Bile or pancreatic duct injury

Benefits

• Relief from symptoms like pain and jaundice
• Improved bile and pancreatic duct function
• Reduced risk of pancreatitis or further complications

Recovery

• Observation for a few hours post-procedure.
• Avoid eating and drinking until the gag reflex returns.
• Mild sore throat or bloating may occur.
• Follow any specific dietary restrictions or medications as advised.
• Schedule follow-up appointments to monitor recovery.

Alternatives

• Percutaneous transhepatic cholangiography (PTC)
• Surgery to bypass or remove the blockage
• Non-surgical bile duct stone removal
• Observation and medicinal management (if appropriate)

Patient Experience

During the procedure, patients will be sedated or under general anesthesia and should not feel pain. Post-procedure, there may be a mild sore throat, bloating, or temporary discomfort. Pain is usually managed with prescribed medications. Most patients can return to normal activities within a few days but should follow specific doctor's orders regarding activity levels and diet.