Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct
CPT4 code
Name of the Procedure:
Endoscopic Retrograde Cholangiopancreatography (ERCP) with Trans-Endoscopic Balloon Dilation of Biliary/Pancreatic Duct(s) or of Ampulla (Sphincteroplasty), including Sphincterotomy, when performed, each duct.
Summary
ERCP with balloon dilation and sphincteroplasty is a minimally invasive procedure that uses an endoscope to diagnose and treat conditions of the bile ducts, pancreatic ducts, or ampulla. The procedure involves dilating ducts using a balloon and may include cutting the sphincter to facilitate better drainage.
Purpose
The procedure addresses conditions such as bile duct stones, strictures, or tumors that obstruct the bile or pancreatic ducts. The goal is to restore normal ductal drainage, relieve symptoms, and prevent complications related to ductal obstructions.
Indications
- Jaundice
- Abdominal pain due to bile duct stones
- Pancreatitis
- Bile duct strictures
- Biliary or pancreatic duct tumors
- Unexplained bile duct dilation
Preparation
- Fasting for at least 6-8 hours prior to the procedure.
- Adjusting or stopping certain medications (e.g., blood thinners).
- Pre-procedure blood tests to assess liver function and clotting status.
- An informed consent discussion about the risks and benefits of the procedure.
Procedure Description
- The patient is sedated or placed under general anesthesia.
- An endoscope is inserted through the mouth, down the esophagus, and into the duodenum.
- A contrast dye is injected into the bile and pancreatic ducts to visualize them on X-ray.
- A balloon is threaded through the endoscope and inflated to dilate any narrowed areas.
- If needed, a sphincterotomy (a small cut in the sphincter muscle) is performed to aid drainage.
- Stones or blockages are removed if present.
- Stents may be placed to keep the ducts open if necessary.
Duration
The procedure typically takes 1 to 2 hours.
Setting
The procedure is usually performed in a hospital's endoscopy suite or an outpatient surgical center.
Personnel
- Gastroenterologist or endoscopic surgeon
- Anesthesiologist or sedation nurse
- Endoscopy nurses and technicians
Risks and Complications
- Infection
- Pancreatitis
- Perforation of the duodenum, bile ducts, or pancreatic ducts
- Bleeding
- Adverse reaction to sedation or contrast dye
Benefits
- Effective relief from symptoms like jaundice and abdominal pain
- Restoration of normal bile and pancreatic duct function
- Minimally invasive with quicker recovery times compared to open surgery
Recovery
- Observation in a recovery area for a few hours post-procedure.
- Discharge on the same day in most cases, unless complications arise.
- Instructions on diet, activity restrictions, and medications.
- Follow-up visits as required to monitor recovery and ductal function.
Alternatives
- Percutaneous transhepatic cholangiography (PTC)
- Surgical bile duct exploration
- Magnetic resonance cholangiopancreatography (MRCP) for diagnostic purposes
Patient Experience
- Mild throat discomfort due to the endoscope.
- Sedation will ensure the patient feels no pain during the procedure.
- Possible abdominal discomfort or bloating post-procedure.
- Pain management typically involves over-the-counter pain relievers.