ERCP

Endoscopic Retrograde Cholangio-Pancreatography or ERCP is an advanced endoscopical & radiological procedure in combination designed for clinical conditions involving the bile duct and the pancreatic duct. It is the procedure of choice in dealing with routine bile duct stones and bile duct narrowing (stricture) which may present clinically as obstructive jaundice. ERCP is also commonly used in managing pancreatic duct diseases as well as dealing with tissue growth found around the ampulla of Vater.

This procedure requires the use of X-rays and a special side-viewing duodenoscope and is carried out in a prone position. A mouth spray and intravenous sedation will be given prior to the procedure to minimise any discomfort. The procedure takes approximately an hour to complete. Once the side-viewing scope is successfully introduced into the duodenum, a thin plastic tube (cannula) will be inserted carefully into the bile duct or pancreatic duct under real time X-ray visualisation to accurately define the problem. Depending on the clinical scenario, various accessories and equipments may be used to complete the procedure. Plastic or metal tubes (stents) may be deployed into the ducts to ensure proper drainage.

ERCP is a complex procedure which carries significant risk. It is therefore mostly performed by endoscopists with sufficient experience in interventional and therapeutic endoscopy. As this procedure requires a significantly longer time to complete, a deeper sedation provided by an anaesthetist may be required. In many centres, an overnight stay is necessary to monitor for ERCP-related complications including, pancreatitis, cholangitis, bleeding and perforation.