ERCP (Endoscopic Retrograde Cholangio-Pancreatography) is an advanced diagnostic procedure which is mainly used to identify stones, tumors and narrowing in the bile ducts. Common Bile Duct (CBD) stones are also known as Choledocholithiasis. It is condition which involves the presence of a gallstone in the common bile duct. The bile duct is the small tube that carries bile from the gallbladder to the intestine. Gallstones usually occur in the gallbladder or pass through the common bile duct. As per the study, many people with gallstones can have gallstones in the bile duct or Choledocholithiasis. ERCP procedure can remove gallstones from the bile duct but not from the gallbladder and it is performed under general anesthesia.
- Cholesterol Gallstones
- Pigment Gallstones
Cholesterol stones are caused by bile that contains too much cholesterol or too much bilirubin or not enough bile salts while pigment stones can occur in people who have biliary duct infection or cirrhosis of liver. People with a history of gallstones or gallbladder disease are at risk for bile duct stone. Obesity, pregnancy, prolonged fasting, rapid weight loss; high calorie and high fat diet increase the chances of developing gallstones.
ERCP (Endoscopic Retrograde Cholangio-Pancreatography) is a combination of two tests i.e. Endoscopy and X-ray.
- GI surgeon performs ERCP procedure to see patient’s gastrointestinal organs clearly. To get best desired results, patient’s stomach should be empty.
- The patient should not eat anything after midnight or before few hours of test. In case the procedure is performed early in the morning, no liquids should be taken or In case the examination is performed at afternoon time then a cup of tea, juice, milk or coffee can be taken eight hours earlier as per the doctor’s advice only.
- Patient should strictly avoid smoking, drinking alcohol or chewing gum during this time.
- Patient should inform doctor well in advance about all medicines or supplements currently taking. Doctor can temporarily ask patient to stop taking medicines or supplements.
The ERCP procedure mainly involves the following steps:
- ERCP procedure is performed under general anesthesia. Before actual starting of ERCP procedure, patient receives a sedative medication intravenously (through a vein) in the arm to get relaxation during the procedure. This helps the endoscope enter into the throat and digestive system.
- In this procedure, GI surgeon or Gastroenterologist inserts an endoscope through the mouth, through the back of the throat, down the esophagus, through the stomach and into the duodenum. Once the papilla of Vater is identified, a small plastic catheter is passed through an open channel of the endoscope into the opening of the papilla and into the bile ducts. Contrast material (dye) is then injected and X-rays of bile ducts are taken.
- Miniature endoscope (Spyglass) is the advanced procedure related to ERCP. In this procedure, miniature endoscope is passed through the operating channel of a duodenoscopy and inserted directly into the bile duct so that inside of the ducts can be easily visualized.
- In many cases, some abnormalities can be treated during ERCP. Gastroenterologist also uses X-ray video which is known as fluoroscopy to see the ducts while carrying out treatment.
- Doctor can place a tiny tube in the duct to treat strictures. The tube called as a stent is placed into the duct through doctor’s endoscope. Then Gallstones can also be removed or dissolved through the endoscope.
- ERCP procedure takes around 1-2 hours. After the completion of ERCP procedure, patient is shifted to a recovery room and his/her health is monitored. After the discharge, patient should visit doctor for regular follow ups.
ERCP is generally a very safe procedure to treat Common Bile Duct (CBD) stones or Choledocholithiasis condition. ERCP is a highly specialized procedure performed by an expert GI surgeon only.