Ercp

ERCP
ERCP is short for endoscopic retrograde

cholangiopancreatography. It is a procedure
that looks at the bile ducts. It is done
through an endoscope.
Bile ducts are the tubes that carry bile
from the liver to the gallbladder and
small intestine.
ERCP is used to treat stones, tumors,
or narrowed areas of the bile ducts.
Description
An intravenous (IV) line is placed in your

arm. You will lie on your stomach or on your
left side for the test.
Medicines to relax or sedate you will
be given through the IV.
Sometimes, a spray to numb the
throat is also used. A mouth guard will
be placed in your mouth to protect
your teeth. Dentures must be
removed.
After the sedative takes effect, the
endoscope is inserted through the mouth. It
goes through the esophagus (food pipe) and
stomach until it reaches the duodenum (the
part of the small intestine that is closest to
the stomach).
You should not feel discomfort, and
may have little memory of the test.
You may gag as the tube is passed
down your esophagus.
You may feel stretching of the ducts as
the scope is put in place.
A thin tube (catheter) is passed through the
endoscope and inserted into the tubes
(ducts) that lead to the pancreas and
gallbladder. A special dye is injected into
these ducts, and x-rays are taken. This helps
the doctor see stones, tumors, and any areas
that have become narrowed.
Special instruments can be placed through
the endoscope and into the ducts.
Why the Procedure is Performed

The procedure is used mostly to treat
problems of the pancreas or bile ducts that
can cause abdominal pain (most often in the
right upper or middle stomach area) and
yellowing of the skin and eyes (jaundice).
ERCP may be used to:
Open the entry of the ducts into the
bowel (sphincterotomy)
Stretch out narrow segments (bile duct

strictures)
Remove or crush gallstones
Diagnose conditions such as biliary
cirrhosis or sclerosing cholangitis
Take tissue samples to diagnose a
tumor of the pancreas, bile ducts, or
gallbladder
Drain blocked areas
Note: Imaging tests generally will be done to

diagnose the cause of symptoms before an
ERCP is done. These include ultrasound tests,
CT scan, or MRI scan.
Risks
Risks from the procedure include:
Reaction to the anesthesia, dye, or
drug used during the procedure
Bleeding
Hole (perforation) of the bowel
Inflammation of the pancreas
(pancreatitis), which can be very
serious
Before the Procedure

1. You will need to not eat or drink for at
least 4 hours before the test. You will sign
a consent form.
2. Remove all jewelry so that it will not
interfere with the x-ray.
3. Tell your health care provider if you have
allergies to iodine or you have had
reactions to other dyes used to take xrays.
4. You will need to arrange a ride home for
after the procedure.
After the Procedure

1. Someone will need to drive you home
from the hospital.
2. The air that is used to inflate the stomach
and bowel during an ERCP can cause
some bloating or gas for about 24 hours.
After the procedure, you may have a sore
throat for the first day. Soreness may last
for up to 3 to 4 days.
3. Do only light activity on the first day after
the procedure. Avoid heavy lifting for the
first 48 hours.
4. You can treat pain with acetaminophen
(Tylenol). DO NOT take aspirin, ibuprofen,
or naproxen. Putting a heating pad on
your belly may relieve pain and bloating.
5. The health care provider will tell you what

to eat. Most often, you will want to drink
fluids and eat only a light meal on the day
after the procedure.
Call your provider if you have:
Abdominal pain or severe bloating
Bleeding from the rectum or black
stools
Fever above 100F (37.8C)
Nausea or vomiting
What Is Choledocholithiasis?
Choledocholithiasis (also called bile duct
stones or gallstones in the bile duct) is the
presence of a gallstone in the common bile
duct. Gallstones usually form in your
gallbladder. The gallbladder is a pear-shaped
organ below your liver in the upper-right side
of your abdomen. These stones usually
remain in the gallbladder or pass through the
common bile duct unobstructed. The bile
duct is the small tube that carries bile from
the gallbladder to the intestine.
According to research published in the
Medical Clinics of North America,
approximately 15 percent of people who
have gallstones develop choledocholithiasis.
Of that 15 percent, an estimated five percent
to 12 percent have primary bile duct stones
(stones that are formed in the bile duct
rather than in the gallbladder) (Attasaranya,
et al., 2008).
What Causes Choledocholithiasis?
Gallstones often pass through the common

bile duct unnoticed. However, about 15
percent of all people with gallstones will
have gallstones in the bile duct.
There are two types of gallstones: cholesterol

stones and pigment stones.
Scientists believe that cholesterol stones
are caused by bile that contains:
too much cholesterol
too much bilirubin
not enough bile salts
They may also occur if the gallbladder does
not empty completely or often enough.
The cause of pigment stones is not known.

They seem to occur in people who have:
cirrhosis of the liver
biliary tract infections
hereditary blood disorders in which the
liver makes too much bilirubin
Who is at Risk for

Choledocholithiasis?
People with a history of gallstones or
gallbladder disease are at risk for bile duct
stones. Even people who have had their
gallbladders removed can experience this
condition.
Some of the risk factors for gallstones can be
improved through lifestyle changes. The
following increase your chances of
developing gallstones:
obesity
low-fiber, high-calorie, high-fat diet
pregnancy
prolonged fasting
rapid weight loss
lack of physical activity
Risk factors you cannot change include:
age: older adults typically have a
higher risk for gallstones
gender: women are more likely to
have gallstones
ethnicity: American Indians and
Mexican-Americans are at higher risk
for gallstones. Gallstones in the bile
duct are more common in Asian
populations
family history: genetics may play a
role
What Are the Symptoms of

Choledocholithiasis?
Gallstones in the bile duct may not cause
symptoms for months or even years.
However, if the blockage becomes severe,
you may experience the following:
abdominal pain in the upper or middleupper abdomen
fever
jaundice (yellowing of the skin and
eyes)
loss of appetite
nausea and vomiting
When a gallstone is stuck in the bile duct,

the bile can become infected. The bacteria
from the infection can spread rapidly. It can
move into the ductal system and then into
the liver. It can become a life-threatening
infection.
The pain caused by gallstones in the bile
duct can be sporadic, or it can linger. The
pain may also be mild at times and then
suddenly severe. Severe pain may require
emergency medical treatment. (The most
severe symptoms are commonly confused
with a cardiac event.)
Diagnosing Choledocholithiasis
If you have symptoms, a doctor will want to
verify the presence of a gallstone in the
common bile duct. He or she may use one of
the following imaging tests:
transabdominal ultrasound (TUS): an
imaging procedure that uses highfrequency sound waves to examine
the liver, gallbladder, spleen, kidneys,
and pancreas
abdominal CT scan: cross-sectional Xrays of the abdomen
endoscopic ultrasound (EUS): an
ultrasound probe is inserted on a
flexible endoscopic tube and inserted
through the mouth to examine the
digestive tract
endoscopic retrograde
cholangiography (ERCP): a procedure
used to identify stones, tumors, and
narrowing in the bile ducts. An
endoscopic tube is inserted through
the mouth and dye is injected into the
ducts where they can be visualized
with X-rays.
magnetic resonance
cholangiopancreatography (MRCP): an
MRI of the gallbladder, bile ducts, and
pancreatic duct.
percutaneous transhepatic
cholangiogram (PTCA): an X-ray of the
bile ducts
Your doctor may also order one or more of
the following blood tests to look for an
infection and to check liver and pancreas
function:
complete blood count
bilirubin
pancreatic enzymes
liver function tests
Treating Choledocholithiasis
Treating gallstones in the bile duct focuses
on relieving the blockage. These treatments
may include:
stone extraction
fragmenting stones (lithotripsy)
surgery to remove the gallbladder and
stones (cholecystectomy)
surgery that makes a cut into the
common bile duct to remove stones or
help them pass (sphincterotomy)
biliary stenting
The most common treatment for gallstones
in the bile duct is biliary endoscopic
sphincterotomy (BES). During a BES
procedure, a balloon- or basket-type device
is inserted into the bile duct and used to
extract the stone or stones. About 85 percent
of bile duct stones can be removed with BES
(Attasaranya et al., 2008).
If a stone does not pass on its own or cannot
be removed with BES, doctors may use
lithotripsy. This procedure is designed to
fragment stones so they can be captured or
passed easily.
Patients with gallstones in the bile duct and
gallstones still in the gallbladder may be
treated with cholecystectomy (gallbladder
removal). While performing the surgery, your
doctor will also inspect your bile duct to
check for remaining gallstones.
If stones cannot be removed completely or
you have a history of gallstones causing
problems but do not wish to have your
gallbladder removed, your doctor may place
biliary stents (tiny tubes to open the
passage). These will provide adequate
drainage and help prevent future
choledocholithiasis episodes. The stents can
also prevent biliary sepsis (inflammation)
and infection.
Bile
Bile is a fluid that is made and released by
the liver and stored in the gallbladder.
Bile helps with digestion. It breaks down fats

into fatty acids, which can be taken into the
body by the digestive tract.
Bile contains mostly cholesterol, bile acids
(also called bile salts), and bilirubin (a
breakdown product of red blood cells). It also
contains:
Water
Body salts (such as potassium and
sodium)
Copper and other metals
Duodenum
The duodenum is the first part of the small

intestine. It is located between the stomach
and the middle part of the small intestine, or
jejunum.
After foods mix with stomach acid, they
move into the duodenum, where they mix
with bile from the gallbladder and digestive
juices from the pancreas.
The absorption of vitamins, minerals, and
other nutrients begins in the duodenum.

Ercp

Uploaded by

Copyright:

Available Formats

Ercp

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ercp

Uploaded by

Copyright:

Available Formats

ERCP

ERCP is short for endoscopic retrograde

An intravenous (IV) line is placed in your

Why the Procedure is Performed

Stretch out narrow segments (bile duct

Note: Imaging tests generally will be done to

Before the Procedure

After the Procedure

5. The health care provider will tell you what

What Causes Choledocholithiasis?

Gallstones often pass through the common

There are two types of gallstones: cholesterol

The cause of pigment stones is not known.

Who is at Risk for

What Are the Symptoms of

When a gallstone is stuck in the bile duct,

Bile helps with digestion. It breaks down fats

The duodenum is the first part of the small

You might also like