The full form of ERCP is endoscopic retrograde cholangio-pancreatography. It is a procedure that determines and helps us scan and visualize the internal structure of the duodenum. It is performed by inserting the duodenoscope (having the camera and light source on a pen like flexible tube) through the mouth.
The duodenoscope passes through the stomach and enter the duodenum, where it is used to determine the structure of the opening of the bile duct and the pancreatic ducts. A plastic catheter is then passed into the bile ducts and pancreatic ducts and the contrast agent is suitably injected to these parts. X—ray imaging of the highlighted portions is then recorded for clear understanding of the internal structure.
ERCP is not a surgery but has been used in conjunction with endoscopic or laparoscopic surgery wherein the target bile obstruction or tissue has to be removed. The removal is done using electric heat or metal tubing that removes the obstruction. ERCP is also used in conjunction with biopsies.
The basic technology used in ERCP is the same in all processes. The targeted organs may differ in different types of ERCP. These are duodenoscopy (imaging the duodenum, bile ducts, gall bladder and surrounding region), colonoscopy (imaging the colon) and pancreatography (imaging the pancreas and pancreatic ducts).
Trained endoscopic specialists who hold certification in handling ERCP equipment and processes perform the ERCP. The ordering doctor might be present in the theatre to administer the right treatment upon diagnosis of a condition within the time period of the test.
When a biopsy or surgery is involved, the ERCP is conducted in the presence of the surgeon.
The ERCP is generally conducted in the radiology lab or the operation theatre as per the patient’s requirement.
Preparation before Surgery:-
ERCP is conducted when the patient has an empty stomach. Therefore, if the procedure is in the early morning, you need to eat light for dinner and fast after midnight. If the procedure is in the late evenings, then you are allowed to have a cup of tea with biscuits four hours before the procedure, not any time later.
If you have heart or blood pressure medications to take, do take them in time with a little bit of water and notify the doctor about it before the procedure. If you have a history of allergy to any anaesthetic agent like Xylocaine, make sure to uniform the doctor prior to the process.
The procedure can take any amount of time between one to three hours. The duration depends upon the patient’s condition and reaction to the sedatives or medication provided during the procedure.
A patient is able to recover complete senses after one to two hours of the procedure.
He is kept in the recovery area under observation while he regains his senses.
Mild sedative will be provided to keep you semi-conscious during the procedure.
Usually an orally administered anaesthetic like Xylocaine is given to patients.
When the patient cannot tolerate local anaesthetics, they are given mild sedative medication intravenously.
During ERCP, the patient will be administered a mild sedative and made to sit or lie down before the duodenoscope is inserted in the mouth.
After the equipment is introduced into the body and the necessary contrast agent has been administered, the X-rays of the upper abdomen are taken and the patient is asked to shift into suitable positions to allow better X-ray imaging of the upper abdomen.
Once the X-rays are completed, any secondary procedure like a biopsy or electrocauter is used if required.
After the procedure is complete, the equipment is withdrawn from the body and the patient is shifted to the recovery room to regain normal consciousness.
After the procedure, the patient is moved to a recovery room where he recovers from the partial consciousness.
The contrast agent and sedative medications may cause mild irritation within the body like gas formation and nausea.
The sensations vanish as the body recovers from the effect of these medications.
The patient need one to two hours after the procedure to be able to sit up straight.
The patient is free to leave the hospital after waking up from sedation which is usually between 1-2 hours.
The ERCP is conducted with mild sedation and the effects of the sedatives remain long after you have recovered from its anaesthetic effects. These include minor digestive turbulences, gas formation and nausea.
The main precautions that you need to take after ERCP is to have an adult drive you home and stay at home for the rest of the day.
Risk and Complications
Please discuss the associated risks and complications with your doctor.
ERCP is an important procedure that helps give a better understanding of the upper abdomen. The liver, gall bladder, bile ducts, stomach, pancreas, pancreatic ducts, the duodenum and the papilla of Vater are important parts of the digestive system which may become vulnerable to one or more diseased conditions.
ERCP helps determine the health of these areas, and if there are any abnormalities observed, ERCP is the best way to find out the exact position, stage and cure of the abnormality.
ERCP is prescribed when multiple abdominal problems are doubted. Conditions studied by ERCP include presence of gall stones in bile ducts, presence of obstructions in bile or pancreatic ducts, presence of tumour in the pancreas, and presence of any secondary growth in the internal lining of the stomach or duodenum.
The cost of ERCP may differ from Rs. 3500 to Rs. 35,000 depending upon the facility that conducts the test, and the type of ERCP.
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