Name of the Procedure:

Endoscopic Retrograde Cholangiopancreatography (ERCP); with biopsy, single or multiple.

Summary

ERCP is a minimally invasive procedure used to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. During ERCP, an endoscope is used to reach the bile and pancreatic ducts. A special dye is injected, making the ducts visible on X-rays. If necessary, tissue samples (biopsies) can be taken during the same session.

Purpose

ERCP addresses blockages, stones, and other abnormalities in the bile and pancreatic ducts. The goals are to identify any issues within these ducts, take biopsies if needed to examine for diseases such as cancer, and potentially treat the problem during the same procedure.

Indications

• Jaundice or yellowing of the skin
• Abnormal liver function tests
• Upper abdominal pain
• Unexplained weight loss
• Suspected bile duct or pancreatic duct blockage
• Pancreatitis of unknown cause

Preparation

• Fast for at least 6-8 hours before the procedure
• Adjustments in medication, especially blood thinners, per doctor's instructions
• Pre-procedure blood tests to assess clotting and liver function
• Ultrasound or MRI may be done prior to ERCP for better imaging

Procedure Description

1. The patient is sedated, usually with conscious sedation; sometimes general anesthesia is used.
2. An endoscope is inserted through the mouth, passing through the esophagus, stomach, and into the duodenum.
3. A catheter is passed through the endoscope into the bile and pancreatic ducts.
4. Contrast dye is injected to make the ducts visible on X-ray images.
5. If abnormalities are found, tools can be passed through the endoscope to take biopsy samples.
6. Additional therapeutic procedures, like removing stones or placing stents, may be performed if needed.

Duration

Typically lasts between 30 minutes to 2 hours, depending on the complexity of the case.

Setting

Performed in a hospital's endoscopy suite or a specialized outpatient clinic.

Personnel

• Gastroenterologist (performing the procedure)
• Anesthesiologist or nurse anesthetist (administering sedation)
• Nurses and technicians (assisting with the procedure)

Risks and Complications

• Bleeding, especially at biopsy site
• Infection
• Pancreatitis
• Allergic reaction to contrast dye
• Perforation of the intestines or ducts
• Adverse reaction to sedatives or anesthesia

Benefits

• Accurate diagnosis of ducts-related issues
• Ability to treat certain conditions immediately (e.g., stone removal, stent placement)
• Quick recovery period compared to surgical alternatives

Recovery

• Monitor in recovery area until effects of sedation wear off
• Avoid driving and strenuous activities for 24 hours
• Follow specific dietary and medication instructions
• Schedule follow-up appointments to review biopsy results and overall recovery

Alternatives

• Magnetic resonance cholangiopancreatography (MRCP) - non-invasive imaging but does not allow for treatment
• Percutaneous transhepatic cholangiography (PTC) - involves a needle inserted through the skin to view bile ducts
• Surgery, which is more invasive with longer recovery

Patient Experience

Patients may feel drowsy and have a sore throat after the procedure. Mild abdominal discomfort is common. Pain management includes over-the-counter analgesics as prescribed. A post-procedure care plan ensures comfort and addresses any complications promptly.