Endoscopic Retrograde Cholangiopancreatography

[lwptoc]

Well, this simply refers to the diagnostic procedure and treatment regimen of problems associated with the bile ducts, liver, pancreas and gallbladder. It uses a combination of fluoroscopic imaging and luminal endoscopy in its procedures for diagnosis and treatment. 

Why will an endoscopic retrograde cholangiopancreatography be requested?

This is requested when there’s a problem with the bile ducts, gallbladder or pancreas. In order to detect the exact cause of the problem, your doctor will request endoscopic retrograde cholangiopancreatography to ascertain the state of the organ and diagnosis to guide on the treatment choice. 

You may also be required to carry out an endoscopic retrograde cholangiopancreatography if you complain of stomach ache, are suffering from jaundice (the condition characterized by yellowing of the skin and eyes) or have been diagnosed of cancer of the pancreas or liver. 

You might also be requested to carry out an endoscopic retrograde cholangiopancreatography procedure if you are have any of the following conditions

• Bile ducts infection.
• Narrowed or blocked pancreatic ducts.
• Blocked bile ducts. 
• Stones in the bile ducts.
• Leaking pancreatic or bile ducts.
• Cancers or tumours.

Diagnostic Procedure and Processes Involved in Endoscopic Retrograde Cholangiopancreatography

This procedure is performed by doctors with specialized training in endoscopic retrograde cholangiopancreatography. The procedure begins with the injection of an intravenous sedative in your arm to tranquillize you and help you stay calm, comfortable and relaxed during the entire procedure. You will also be given an anaesthetic to numb your throat and help prevent gaggling while the procedure lasts. The anaesthetic could be in a liquid form which is gargled or a spray that is applied on the back of the throat. 

The next step will then be to lie flat on an examination bed. An endoscope (which is a flexible long tube fitted with a tiny camera and light at the tip) is then passed through the mouth, to the oesophagus, from there it goes through the stomach to the duodenum. This is done to carry out a proper examination of the digestive system and see the current status of the digestive system. Air may also be pumped to enable footage of the full digestive system.

The tiny camera mounted at the edge of the endoscope serves as the doctor’s eyes inside the digestive system by providing video footage of the things in the digestive systems. Thereby, making it easier for the doctor to carry out proper assessment and examination.

This aids the doctor to be able to identify where the intestine and the bile ducts come together and insert a tiny plastic tube (known as a catheter) into the ducts. With the aid of the catheter, a special dye agent, known as a contrast medium (or contrast agent) is injected. This helps make the pancreatic and bile ducts, and gallbladder more visible. While all these are going on several x-rays are being taken.

The X-ray imaging procedure used is what is known as Fluoroscopy. The X-ray helps to properly examine the ducts for possible blockage and narrowed areas.

If need be, other (tiny) tools may also be passed through the endoscope to 

• Open up blocked ducts.
• Open up and widen narrowed ducts.
• Removes tumours that may be found in the ducts.
• Perform biopsy if necessary.
• Break up the stones that may be found, and subsequently remove the stones.
• Insert stents (a tiny tube used in opening narrowed ducts) to stop leakages from the bile.

The whole procedure is likely to last about 2 hours.

How safe is the endoscopic retrograde cholangiopancreatography?

Generally, endoscopic retrograde cholangiopancreatography is considered a low-risk procedure. However, those undergoing the procedure for treatment, like the removal of gallstone, are at an increased risk for developing complications. While those undergoing the procedure for diagnosis are at a lesser risk of developing complications. 

Hence, there’s a certain level of safety. However, the doctor carrying out the procedure will discuss the issue of complications with you before embarking on the procedure.

Preparing for an endoscopic retrograde cholangiopancreatography

If you’re preparing to undergo the endoscopic retrograde cholangiopancreatography, you will need to 

1. Have a chat with the doctor carrying out the procedure.

This, perhaps, is the very first step you need to take. You need to have a discussion with the doctor to walk you through the procedures and processes and any likely complications. On your part, you must also tell the doctor your medical history, that is, your health status, medical condition (terminal or otherwise) such as diabetes, hypertension, heart disease, kidney status, lungs condition, and so on; allergies, medications, vitamins and supplements, and for women you need to tell the doctor your pregnancy status, so that the doctor may take necessary steps and precautions to help protect your baby.

The doctor will then advise you on steps to be taken.

2. You will have to avoid consumption of food and water, for a period of 8 hours before the endoscopic retrograde cholangiopancreatography procedures begin. Also, you must avoid chewing (anything whatsoever) or smoking for the same period of hours. In other words, you will have to fast 8 hours before the commencement of the procedures.
3. If the need arises, you may spend the night or a couple of days in the hospital to ensure proper care and stability before being allowed to go home.
4. In the case of discharge immediately after carrying out the procedure, you will have to arrange for a ride home, as it is advisable not to involve in heavy-duty activities for about 24hours after the procedures. Also, the sedatives that will be given before the commencement of the procedure will make you feel drowsy and sleepy. You don’t want to sleep off while driving. And more importantly, you need enough and proper rest.
5. Lastly, you will be required to sign a consent form giving authorisation for the procedure to be carried out.

The aftermath of an ERCP, what happens?

When the ERCP procedure is over, you will immediately be transferred to a recovery room for observation. Then as soon as your pulse, blood pressure and breathing stabilize and you become conscious you will be taken to a hospital room or be discharged.

You will be denied eating and drinking until your gag reflex returns, and may suffer sore throat and feel pain while swallowing, but this only last for a couple of days. 

You should examine yourself and tell the doctor how you feel. It is best advised to stay the night in the hospital in case of an emergency.

Possible complications that may occur after an ERCP procedure?

These chances of complications are quite low. However, a number of complications may arise after an ERCP procedure. These include

• Cholecystitis (which is the inflammation of the gallbladder) or pancreatitis (the inflammation of the pancreas). 
• Tears and haemorrhage (excessive bleeding).
• An infection of the gallbladder or the bile ducts. 
• Reaction to the sedative given. This could be cardiac, abdominal or respiratory.
• Exposure to the radiation of the X-ray may cause damage to the tissue.
• Death. Although, this is a very rare complication.