Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

Overview

What is it? ERCP is a procedure that allows your doctor to see the small tubes that connect the liver, the gallblader and the pancreas with your intestine. The two main tubes are called the common bile duct and the pancreatic duct, respectively. Both tubes are entering in the bowel just after your stomach, in the part of the small bowel which is called duodenum. The tubes carry digestive juices from your liver and pancreas to the intestines.
For the ERCP a camera test is performed with an endoscope which goes through your mouth into your stomach and from there in the first part of the small bowel, the duodenum. In the duodenum the doctor first finds the opening of the bowel where the bile duct and the pancreatic duct drain – this is called the ampulla. The next step is to put a small plastic tube through the endoscope in the ampulla and inject some dye which shows up on X-rays. The procedure allows the doctor to see the ducts and how they are working
Why it happens: An ERCP can identify and treat problems in the pancreatic duct and in the bile duct. There are many different reasons why you might be required to have an ERCP. The most common reasons are
Yellow skin or eyes (jaundice), light stool and dark urine
Stones in the bile or pancreas duct
A lesion or tumor in the pancreas, gallbladder, or liver
Frequency: In the Western World, 10-15% of the population has gallstones. Most are asymptomatic and the patients may not even be aware of the presence of gallstones in their gallbladder. Only 1-4% of patients with gallstones will suffer from biliary colic.

Symptoms

• The main symptom is a sharp pain in the right side of the abdomen just below the ribs. The pain can be so severe that it may affect breathing as well. Other symptoms may include fever, nausea, vomiting, sweating, loss of appetite, yellow skin and/or yellowing of the white of the eyes.
• Subacute/chronic presentation – less frequently, a femoral hernia will present as a bulge in the area of the groin, just below the crease of the groin. The bulge may or may not be painful on palpation and it may or may not be reduced when lying flat. Even when presenting without acute pain it is still recommended that a femoral hernia is repaired surgically. This is because femoral hernias are likely to strangulate.

Diagnosis

In most cases a careful medical history and a physical examination will raise the suspicion of the diagnosis. The diagnosis is established when a scan confirms the presence of gallstones and inflammation around the gallbladder (most commonly an ultrasound but it could also be a CT scan or an MRI scan. Blood tests can be helpful too.

Treatment

Treatment for acute cholecystitis is likely to require a hospital admission. In the initial, acute stages, you will be kept nil by mouth (no eating or drinking) and you will be prescribed fluids for hydration and medication to relieve your pain. Antibiotics may also be required if the gallbladder is infected. You will probably require treatment for up to a week – depending on how you respond to treatment you may need to stay in hospital, or you may be able to go home and complete your treatment orally.
The definitive treatment for all patients who are fit to udergo surgery is removal of their gallbladder. The timing for the operation will be decided by your surgeon (see HOT CHOLECYSTECTOMY). The operation prevents acute cholecystitis from coming back and reduces the risk of complications related to gallstones.
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Follow Up

If you’ve had an episode 
  • It is important to follow all your doctor’s instructions, take any medication prescribed regularly and keep your follow-up appointments.
  • Getting out of bed and walking is an important part of recovery and helps prevent complications.
  • Try to follow a healthy diet and ideally to lose some weight in anticipation of your surgery. If you had your surgery (see HOT CHOLECYSTECTOMY) then follow the postoperative instructions of your surgeon
  • Usually you should be able to go back to a normal diet withing 2-4 weeks from the episode of acute cholecystitis.
  • Take steps to avoid becoming constipated. Eat lots of fiber, drink plenty of fluids, exercise, and go to the bathroom when you feel the urge.
Seek immediate medical attention if
  • You are having symptoms of acute cholecystitis
  • If the pain excruciating and is lasting for hours
  • If you are jaundiced (turned yellow), your urine is very dark or your stool is pale