ERCP, which stands for endoscopic retrograde
cholangiopancreatography, is a procedure that enables
physicians to examine and treat problems arising the
bile ducts and pancreas. This is best done by The
patient is sedated or anaesthetized. Then a flexible
camera (endoscope) is inserted through the mouth, down
the esophagus, into the stomach, through the pylorus
into the duodenum where the ampulla of Vater (the
opening of the common bile duct and pancreatic duct)
exists. The sphincter of Oddi is a muscular valve that
controls the opening of the ampulla. The region can be
directly visualized with the endoscopic camera while
various procedures are performed. A plastic catheter or
cannula is inserted through the ampulla, and
radiocontrast is injected into the bile ducts, and/or,
pancreatic duct. Fluoroscopy is used to look for
blockages, or other lesions such as stones.
needed, the opening of the ampulla can be enlarged with
an electrified wire (sphincterotome) and access into the
bile duct obtained so that gallstones may be removed or
other therapy performed.
associated with ERCP include the trawling of the common
bile duct with a basket or balloon to remove gallstones
and the insertion of a plastic stent to assist the
drainage of bile. Also, the pancreatic duct can be
cannulated and stents be inserted. The pancreatic duct
requires visualisation in cases of pancreatitis.
In specific cases, a second camera can be inserted
through the channel of the first endoscope. This is
termed duodenoscope-assisted cholangiopancreatoscopy
(DACP) or mother-daughter ERCP. The daughter scope can
be used to administer direct electrohydraulic
lithotripsy to break up stones, or to help in diagnosis
by directly visualizing the duct (as opposed to
obtaining X-ray images).
The gallbladder should
be surgically removed (cholecystectomy) following
successful removal of gallstones from the bile ducts.