Name of the Procedure:

Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation.
Common name(s): ERCP (Endoscopic Retrograde Cholangiopancreatography)

Summary

This procedure is a minimally invasive technique used to examine and treat problems in the bile ducts and pancreatic ducts. It combines endoscopy with fluoroscopy, allowing doctors to visualize and access these ducts to remove blockages, take biopsies, or place stents.

Purpose

The procedure addresses conditions such as bile duct stones, strictures (narrowing), leaks, and tumors. The goal is to provide relief from symptoms like jaundice, pain, and inflammation, and to obtain diagnostic information about the ducts.

Indications

• Jaundice
• Abdominal pain
• Pancreatitis
• Suspected or confirmed bile duct stones
• Leakage of bile
• Suspicion of cancer or strictures in the bile or pancreatic ducts

Preparation

• Fasting for 6-8 hours prior to the procedure.
• Adjustments in medication, especially blood thinners or anticoagulants.
• Pre-procedure blood tests to check clotting function and overall health.
• Arranging for a ride home post-procedure due to sedation effects.

Procedure Description

1. The patient receives sedation or anesthesia.
2. An endoscope is inserted through the mouth, passing through the stomach to the duodenum.
3. A catheter is used to inject a contrast dye into the bile and pancreatic ducts.
4. Radiological images are taken to visualize the ducts.
5. Depending on findings, the doctor may remove stones, perform biopsies, or place stents.
6. The endoscope is then carefully withdrawn.

Tools: Endoscope, catheter, contrast dye, fluoroscopy equipment.
Anesthesia: Sedation or general anesthesia, depending on patient and procedure complexity.

Duration

Typically, the procedure takes about 30 minutes to 1 hour.

Setting

Usually performed in a hospital or an outpatient surgical center with specialized endoscopy suites.

Personnel

• Gastroenterologist or specialized endoscopist
• Radiologist
• Anesthesiologist or nurse anesthetist
• Nurses and/or endoscopy technicians

Risks and Complications

Common risks:

• Sore throat
• Bleeding at the insertion or intervention site
• Mild pancreatitis

Rare risks:

• Infection
• Perforation of the gastrointestinal tract
• Severe pancreatitis
• Adverse reactions to contrast dye

Benefits

• Relief from symptoms like pain, jaundice, and infection.
• Minimally invasive, often resulting in quicker recovery compared to surgery.
• Provides definitive diagnosis and immediate treatment of ductal issues.

Recovery

• Observation in the recovery area for a few hours post-procedure.
• Instructions to avoid eating or drinking until the throat numbness has worn off.
• Avoiding heavy lifting or strenuous activities for 24-48 hours.
• Follow-up appointments to monitor for complications or assess the outcome of interventions.

Alternatives

• MRCP (Magnetic Resonance Cholangiopancreatography): Non-invasive imaging without therapeutic capability.
• Percutaneous Transhepatic Cholangiography (PTC): Imaging and intervention via needle puncture through the liver.
• Surgery: More invasive with longer recovery time but may be necessary in certain cases.

Patient Experience

During the procedure, patients are typically sedated and should not feel pain. Post-procedure, there may be a sore throat and mild abdominal discomfort. Pain and discomfort are usually manageable with over-the-counter pain relief and rest.