19 March 2019 What is an ERCP? Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic examination used in the field of gastroenterology that combines X-rays and endoscopy to enable the assessment of : Bile ducts; Pancreatic ducts; Gallbladder. The bile ducts drain into the duodenum (the first part of the small intestine), in the area of a structure known as the papilla of Vater . How is an ERCP carried out? The ERCP is carried out in a room containing X-ray equipment , with the patient lying face down . A long, flexible tube called a duodenoscope is introduced through the mouth . The duodenoscope has a light source and a video camera at one end that transmit amplified, high-definition images to a monitor in the room where the scan is being performed. The doctor can then make a detailed examination of the path followed by the duodenoscope. The duodenoscope also has components that enable the painless harvesting of tissue fragments (biopsy) and the introduction or removal of fluids and air, as well as instruments necessary for any procedures that may need to be carried out. When the duodenum is reached and the papilla of Vater identified, a catheter is introduced through the duodenoscope. This allows the administration of a contrast product to the bile and pancreatic ducts. Subsequently obtained X-ray images then make it possible to visualise and evaluate these structures. This examination is always performed under anaesthetic , which significantly reduces the discomfort that can be associated with it. These examinations are generally carried out while the patient is in hospital . Usually, the patient needs to remain in hospital for 24 hours after the examination has been carried out. In what situations is an ERCP carried out? It is always for the doctor to decide whether there is a need for a particular test, depending on the individual characteristics of each patient and their specific complaints or illness . As a rule, the most common reasons for carrying out an ERCP include the following, among others: Removal of bile duct calculus (this is the most common cause); Detection of stenosis (narrowing), obstructions, irregularities and lesions of the bile ducts and changes in the biliary and pancreatic flow; Symptoms that might suggest such changes; Investigation of cases of jaundice where involvement of the bile ducts is suspected; Carrying out of biopsies; Clarification of findings from other examinations. Is any preparation needed before carrying out an ERCP? Given this is a procedure that aims to provide a detailed visualisation of the route covered by the duodenoscope, it is essential there is no food present . If preparation is not carried out correctly, complications may occur. A pre-fasting period of 6 hours is necessary before ERCP can be carried out. On the date the examination is scheduled, you will be provided with all of the necessary information on how to prepare for it and on the care that you will require after the examination has taken place. These instructions must be followed scrupulously . Failure to do so may mean it is not possible for the examination to be carried out, as its usefulness may be affected or the risks involved may be increased. How long does the ERPC take? An ERPC takes on average around 30 to 60 minutes . However, it may take longer, especially if there is a need for any additional procedures. After the scan is complete, the patient should wait until they have fully recovered . This period should be spent resting in a place specially designed for this, before the patient returns to the hospital room . What are the limitations of the ERPC? As with any other examination, the ERPC may miss lesions and diagnoses , even when it is carried correctly. At the hospitals and clinics of the Hospital da Luz network, you can find doctors specialising in gastroenterology who will be able to carry out any examinations necessary for your situation. This article was written with the support of physicians and other clinical professionals from the Hospital da Luz network . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
