What is Endoscopic Retrograde Cholangiopancreatography (ERCP)?

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With the advances in medicine, it is possible to diagnose, prevent and treat various diseases that would not have been possible decades ago.

Stay with us in reading this article and learn about endoscopic retrograde cholangiopancreatography (ERCP) and how it is used to diagnose and treat diseases of the biliary and pancreatic system.

What is ERCP?

ERCP, an acronym that refers to endoscopic retrograde cholangiopancreatography, is a medical procedure done to diagnose and treat a series of diseases of the biliary tract, both inside (hepatic ducts) and outside the liver (common bile duct) and the pancreatic ducts (Wirsung and Santorini ducts).

Diseases that affect the pancreatic ducts and biliary tract present symptoms such as abdominal pain, pale skin, fever, yellowish eyes, and changes in pancreatic and hepatic enzymes.

These symptoms may appear due to biliary tumors, chronic pancreatitis, cysts and pancreatic tumors, inflammatory stenosis, complications of surgeries performed on biliary tracts, liver diseases and mainly due to the impaction of calculi (stones) that migrated from the gallbladder.

How is ERCP performed?

The ERCP exam is performed with venous anesthesia or sedation, under the supervision of a qualified professional, with the aim of relaxing and putting the patient to sleep.

A flexible device is introduced into the individual’s mouth, taken until it reaches the second duodenal portion of their body during the procedure.

The device has a side light and camera, allowing the duodenal papilla to be visualized, where the biliary and pancreatic ducts end together, releasing their secretions into the duodenum.

A special material is placed inside the duodenal papilla, which will perform the radiological evaluation of the anatomy of the Wirsung duct and the biliary tract.

This is possible thanks to an injection of radiopaque contrast along with serial radiographs taken over the abdomen.

The images obtained by ERCP are analyzed by the endoscopist doctor who will decide at the same time for the best treatment for the patient, which may include procedures such as papillotomy, drainage of inflammatory or tumoral stenoses, through an endoscopic prosthesis or by a probe, removal of stones that are obstructing the biliary tract and other necessary procedures.

Indications of ERCP

As already mentioned, ERCP is an endoscopic procedure indicated to evaluate and treat various conditions related to biliary and pancreatic pathology. Some of the situations in which ERCP may be recommended include:

• biliary obstruction secondary to choledocholithiasis;
• benign and malignant stenoses of the bile duct;
• biliary fistulas;
• dysfunction of the Oddi sphincter;
• recurrent acute pancreatitis of unknown cause;
• chronic pancreatitis with symptomatic stenoses;
• symptomatic lithiasis of the pancreatic canal;
• treatment of symptomatic pancreatic pseudocysts;
• diagnosis of malignant neoplasms of the pancreas.

Risks and complications of ERCP

ERCP is an invasive procedure, so there is a small possibility of risks to the patient.

Some problems can occur during the procedure due to the individual’s reactions to sedation or anesthesia, or due to reactions related to therapeutic procedures and diagnostic exams.

The medications used for sedation can cause reactions in the individual, such as phlebitis at the site of venous puncture, and systemic, affecting the cardiorespiratory system, including reduction of blood oxygenation and heart rate, as well as changes in blood pressure.

During the exam, if there are side effects, they will be continuously monitored through the control of the patient’s heart rate and blood pressure and also, with the use of devices such as a blood oxygenation monitor.

The medical team is trained to immediately treat any of these complications.

Possible complications related to the ERCP exam include gastrointestinal bleeding, abdominal pain, pancreatitis, duodenal perforation, and abdominal distension.

The most common complication to occur is acute pancreatitis, which appears in 1% to 7% of cases. Perforation and bleeding are rarer events, with an occurrence of 0.3% to 0.6% and 0.8% to 2% of cases, respectively, mainly in patients undergoing papillotomy.

Biliary tract infection (cholangitis) can occur in approximately 1% of cases, especially in individuals who have benign or malignant stenoses.

These problems increase the patient’s hospital stay and may require care involving the use of antibiotics or even therapeutic surgery, however, as shown, they are of low incidence, and the doctor who performs the ERCP is also trained to identify and treat these complications.

Recovery after ERCP

After the ERCP is performed, the patient will have to rest completely for up to half an hour, so that the effects caused by the sedative medications disappear. It is possible that his throat will present irritations, accompanied by a slight discomfort in the stomach.

In certain situations, if the patient has received supplemental oxygen while performing the procedure, he may feel nasal congestion or have some sneezes.

If requested, he may receive analgesic medications.

After the procedure, it is recommended to fast for 8-12 hours. However, if no therapeutic procedure was performed, it is possible that a lighter diet or based on liquids may be released.

The day after performing the ERCP, or if there are no intercurrences, the doctor will grant hospital discharge.

At this time, the patient can return to eating normally and take his routine medications, unless he has received specific instructions from the doctor to the contrary.

The professional who requested the exam is the most suitable to provide guidance on what was visualized. Additional information about the diagnosed problem and treatment will be provided in a subsequent consultation.

If biopsies were taken during the procedure, the analysis will be performed by a specialized pathology laboratory of your choice, and the results will be delivered within the time established by the laboratory.

If you have undergone any medical therapy, the endoscopist professional will provide additional relevant information.

It is important to be accompanied by an adult who can provide assistance, as the medication used can momentarily alter your ability to reason and make decisions.

ERCP should be performed by a team of professionals trained to serve the patient with excellence, with the aim of avoiding possible complications and also to help the individual recover after the end of the procedure. Therefore, always seek a specialist.

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