Choose the content to read
- What are the indications symptoms for a diagnostic ERCP?
- Diseases can be diagnosed and/or treated with ERCP
- What is the ERCP procedure?
- What are the risks or complications of ERCP procedure?
- What are the benefits of ERCP?
ERCP (Endoscopic Retrograde Cholangiopancreatography)
ERCP (Endoscopic retrograde cholangiopancreatography) is a minimally invasive diagnostic and treatment procedure for pancreatic and biliary tract diseases involves passing an endoscope through the mouth, esophagus, and stomach, down into the duodenum to the ampulla of Vater, followed by injecting a contrast dye, taking a series of X-ray images, and projecting them up on the screen to check for diseases or abnormalities related to biliary and pancreatic ducts, including choledocholithiasis, pancreatic duct stones biliary or pancreatic duct leakages, tumors, or cancer of the biliary tract or pancreas, the cause of severe epigastric pain, yellowing of the skin and eyes (jaundice), nausea, and vomiting. ERCP can remove gallstones without open surgery, effectively treat jaundice, and detect tumors, fibrosis, or pancreatic cancer quickly, allowing for timely treatment of the involved organ.
What causes biliary and pancreatic stones?
What are the indications symptoms for a diagnostic ERCP?
- Abdominal pain on the right-upper abdomen, under the right rib cage, and/or radiating to the back.
- Epigastric pain (upper stomach pain), biliary colic
- Jaundice (yellowing of the skin and eyes)
- Nausea, vomiting
- Fever, chills
- Flatulence, indigestion
- Loss of appetite, weight loss
- Difficulty swallowing, severely sore throat
- Tea-colored urine, dark-colored urine
- White stools, clay-colored stools
Diseases can be diagnosed and/or treated with ERCP
- Biliary tract diseases
- Choledocholithiasis
- Biliary stenosis
- Biliary fibrosis
- Bile duct leaks
- Cholangitis
- Infection of the gallbladder or bile duct
- Biliary obstruction
- Sphincter of Oddi dysfunction (SOD)
- Bile duct tumor
- Bile duct cancer (cholangiocarcinoma)
- Primary sclerosing cholangitis (PSC)
- Pancreatic diseases
- Pancreatic duct stones
- Pancreatic duct strictures
- Pancreatitis
- Pancreatic cysts and tumors
- Pancreatic cancer
What is the ERCP procedure?
ERCP (endoscopic retrograde cholangiopancreatography) procedure at MedPark Hospital follows an international gold standard in diagnostic and treatment guidelines, prioritizing patient safety and treatment success. Patients undergoing ERCP will require admission to the hospital 24 hours after the procedure to ensure they are free from complications and can return home the next day when the result of a physical examination is in good condition.
Preoperative ERCP procedures
- Individuals with a history of drug allergies, seafood allergies, or contrast dye allergies must notify the gastroenterologist before proceeding with the procedure in order to select an appropriate contrast dye.
- Refrain from taking antiplatelet drugs or blood thinners such as Aspirin or Plavix for at least 7 days.
- Refrain from food, smoking, and beverages for at least 6-8 hours prior to the procedure, except for an occasional sip of water.
- Those who wear removable full or partial dentures, including orthodontic retainers, must remove them before the procedure.
- Individuals undergoing the ERCP must be accompanied by a family member who can make a substitute decision if the gastroenterologist determines that the patient requires immediate intervention or surgery.
Intraoperative ERCP procedures
- The anesthesiologist will consider giving local anesthesia, throat spray, or intravenous (IV) sedation, depending on the appropriateness of the patient and the anesthesiologist's discretion.
- The gastroenterologist or a nurse will place a mouthguard and place the patient in a side-lying position.
- The gastroenterologist inserts a slender, flexible endoscope with a built-in magnifying lens and an fiberoptic light, which will pass through the mouth and descend into the esophagus, stomach, and the first part of the small intestine (duodenum) until it reaches the ampulla of Vater, the confluent opening of the distal pancreatic and common bile duct.
- The gastroenterologist will insert a catheter into the ampulla to inject a dye contrast to allow clear visualization of the ducts under fluoroscopy. Then, X-ray images will be taken from various angles and projected on the screen to check for pancreatic and biliary tract diseases, including stones, stenotic regions, or blockages.
- If the gastroenterologist detects papillary stenosis or biliary dyskinesia causes biliary tract stenosis or obstruction, they will perform a sphincterotomy and stent placement to enlarge the ampulla, facilitating bile and pancreatic juice drainage into the duodenum to relieve symptoms related to jaundice.
- If the gastroenterologist detects biliary duct stones, they will use a basket-shaped wire attached to the tip of the endoscope to hook the gallstone and remove it out from the bile duct or pancreatic duct using an electric current at the tip of the wire. Stones will fall into the small intestine and be excreted from the body through the excretion of the colon and rectum.
- In another method, the gastroenterologist removes the stone using a balloon catheter to push the stone up and out of the biliary tract by stabbing the tip of an endoscope through the other side of the stone and then inflating a balloon attached to the tip of the endoscope and slowly dragging the stones out of the bile duct or pancreatic duct. Stones will then fall into the small intestine and waste out of the body.
- In cases of complications, such as gallstones falling and becoming lodged in the gallbladder, a large number of gallstones, fibrosis, or suspicious lesions, the gastroenterologist will determine immediate intervention with minimally invasive laparoscopic cholecystectomy (LC) or taking a biopsy for microscopic examination in a pathology department.
- Once the ERCP procedure is completed, the gastroenterologist will gently withdraw the endoscope back, remove the mouthguard, lie the patient in a supine position, and keep them warm while periodically assessing symptoms and vital signs. Typically, the ERCP procedure takes approximately 1-2 hours.
Postoperative ERCP procedures
- The gastroenterologist will have the patient recover at the hospital for 24 hours to monitor possible complications, such as biliary duct or pancreatic duct infection, which can cause acute cholangitis or acute pancreatitis.
- The gastroenterologist will ask the patient to still abstain from drinking and eating for at least 6-8 hours after the procedure to prevent possible complications. If there are no complications or symptoms like abdominal pain, colic, distension, nausea, vomiting, or a high fever, the gastroenterologist will allow the patient to take sips of water, eat soft food, and return home.
- The gastroenterologist will schedule a date and time to follow up on symptoms after diagnosis and treatment.
What are the risks or complications of ERCP procedure?
Common side effects following ERCP include a slight sore throat or bloating caused by air pressure from balloon inflation during the procedure. These side effects are temporary and short-lived and will eventually go away. However, some complications may occur after the ERCP procedure, as follows:
- Acute pancreatitis occurs in 3–5% of cases, with symptoms of abdominal pain, nausea, and vomiting within 24 hours of the procedure due to long-term biliary or pancreatic duct blockage. The gastroenterologist will provide consistent treatment and conduct periodic symptom checks. Usually, symptoms will gradually disappear in 2–3 days.
- Infections occur in 5–10% of cases, presenting abdominal pain and fever. Bacteria are commonly the source of infection during bile drainage from the biliary and pancreatic ducts. The gastroenterologist will administer antibiotics and monitor symptoms until the infection is resolved.
- Bleeding occurs in 2.5–5% of cases, particularly in those who must temporarily discontinue anticoagulant medication before proceeding with the procedure. Bleeding can be due to the sphincterotomy to dilate the ampullary opening to remove stones or an ulcer in the duodenum, which typically occurs 24 hours after the ERCP. However, symptoms will gradually subside once the gastroenterologist allows the patient to continue taking antiplatelet medications.
What are the benefits of ERCP?
- ERCP procedure is both diagnostic and therapeutic, time-saving, and cost-effective.
- Highly safe, low risks, low complications, and high success rate of up to 95%.
- No surgery, no surgical wound (*exception: the gastroenterologist continues with the surgery).
- Minimally invasive, less painful, no blood loss or minimal blood loss.
- Less tissue damage, milder internal organ injuries.
- Short treatment time of only 1-2 hours.
- Short-term hospitalization with a 24-hour length of stay.
- Quick recovery rapidly returns to work and life.
- Suitable for the elderly, vulnerable, or underlying diseases.
- Treatment efficiency is equivalent to surgery.
- Improve the quality of life.
- Effectively detect tumors, fibrosis, or early-stage cancer, leading to timely treatment
ERCP at MedPark Hospital
Gastrointestinal and Liver Center, MedPark Hospital, Bangkok, Thailand is led by a team of leading gastrointestinal and liver specialists and surgeons who are fully prepared to provide seamless diagnostic and therapeutic for challenging and complex biliary tract and pancreatic diseases using international standard operating room for ERCP and surgery, enabling minimal incisions, less painful, and a quick recovery integrated with state-of-the-art medical technology and equipment and advanced medical techniques, ensuring safe, fast, and precise treatment, contributing to treatment efficiency while providing follow-up and evaluation after the treatment to ensure the patient is safe from complications, recovers quickly, has a good quality of life, and is physically healthy.
