Endoscopic retrograde cholangiopancreatography (ERCP); with removal and exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchang
CPT4 code
Name of the Procedure:
Endoscopic Retrograde Cholangiopancreatography (ERCP); Removal and Exchange of Stent(s)
- Technical/Medical Terms: ERCP, biliary stent exchange, pancreatic duct stent exchange, sphincterotomy.
Summary
ERCP is a specialized procedure where a doctor uses an endoscope to remove and replace stents in the bile or pancreatic ducts. This may involve dilating (widening) the ducts and cutting the sphincter muscle if necessary.
Purpose
Medical Conditions: Blocked or narrowed bile and pancreatic ducts, usually due to gallstones, tumors, or chronic pancreatitis. Goals: To clear any obstructions, replace faulty stents, and ensure proper duct function, thereby relieving symptoms like jaundice, pain, or infection.
Indications
Symptoms: Jaundice, abdominal pain, recurring pancreatitis, or bile duct stones. Criteria: Patients with confirmed duct obstruction or malfunctioning stents needing replacement.
Preparation
Instructions:
- Fasting for 8-12 hours before the procedure.
- Adjustments in medications, particularly blood thinners. Tests: Blood tests, imaging studies (like ultrasound or MRI), possibly EKG depending on patient history.
Procedure Description
- Sedation: Patient is given sedatives or anesthesia.
- Endoscopy: A thin, flexible tube (endoscope) is introduced through the mouth, down the esophagus, and into the stomach and small intestine.
- Duct Access: A contrast dye is injected to highlight the ducts on X-rays.
- Stent Removal/Exchange:
- Pre-dilation and guide wire placement may be performed to open up ducts.
- Old stents are removed, new stents are inserted.
- Sphincterotomy: The sphincter muscle may be cut to allow better drainage.
- Final Check: Ensure stent placement and duct patency with X-rays.
Tools/Equipment: Endoscope, X-ray machine, guide wires, dilation balloons, stents.
Duration
Typically takes between 30 minutes to 2 hours.
Setting
Performed in a hospital endoscopy unit or a specialized outpatient surgical center.
Personnel
- Gastroenterologist, specially trained in performing ERCP.
- Nurses and support staff.
- Anesthesiologist or sedation nurse.
Risks and Complications
Common Risks: Mild throat discomfort, temporary bloating or cramping. Rare Risks: Infection, pancreatitis, bleeding, perforation of the digestive tract. Management: These complications, if they occur, are managed with medications, additional procedures, or surgery.
Benefits
Expected Benefits:
- Immediate relief from duct obstruction symptoms.
- Improved bile or pancreatic juice flow. Timeline: Benefits are usually noticed within days.
Recovery
Post-procedure Care:
- Observation in a recovery room until sedation wears off.
- Instructions on diet, activity level, and medication. Recovery Time: Most patients go home the same day. Full recovery in a few days. Follow-up: Appointment with the healthcare provider to review the results and plan further care.
Alternatives
Other Options:
- Percutaneous transhepatic cholangiography (PTC).
- Surgical stent placement or duct repair. Comparison: Alternatives might be more invasive, require longer recovery, or have different risk profiles.
Patient Experience
During the Procedure:
- Sedation usually ensures no pain or discomfort during the procedure. After the Procedure:
- Mild sore throat, bloating, or cramping.
- Pain management includes over-the-counter pain relief or prescribed medications.