Endoscopic Retrograde Cholangiopancreatography (ERCP) | Diseases and conditions: Medical tests.

What is Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic Retrograde Cholangiopancreatography, better known simply by his acronym ERCP, is a medical technique that exists since the end of the 1960's. Combines endoscopy and Radiology: on the one hand an endoscope is introduced from the mouth to the higher parts of the digestive tract and the technique by injection of contrast which is detected through x-rays, as it happens in the catheterization is controlled by another.
The endoscope used is more complex than that used for the gastroscopias or colonoscopies. It has a side camera, allows the injection of substances and at its end has different endings getting to perform complex techniques avoid surgeries of the digestive system. It is mainly used to solve problems of the bile, as gallstones, but they are also used for diseases of the pancreas and to address surgical complications.
The doctor who performs this technique is the gastroenterologist, the specialist in the digestive tract. He decides whether it is worth conducting the test based on previous data such as medical history and imaging (ultrasound, CT scan, etc). To undergo the test the patient will be slightly sedated, avoiding deep anesthesia and its risks. It may be somewhat uncomfortable, but never painful.
ERCP complications are rare. The most common are mild gastrointestinal upset and that can be solved on their own hours after undergoing the technique. Other more serious, such as intestinal perforation, are uncommon and require emergency surgery. Thank you for this test are avoided more complex digestive surgery requiring general anesthesia. It is therefore a "operation through the mouth".

When an ERCP is done

You must perform an ERCP (Endoscopic Retrograde Cholangiopancreatography) when it is necessary to study or intervene on the bile ducts from the digestive tract, the ducts that carry bile from the liver to the small intestine. It can also be useful in certain pathologies of the duodenum (first part of the small intestine) and pancreas.
Before performing an ERCP usually necessary to test image showing the problem of the digestive system:
Gallstones: gallstones are real stones that form in the gallbladder and bile duct, producing obstructions that can be complicated with accumulation of bilirubin in the body, pancreatitis and abdominal pain can go. When the stones are the best solution in the gallbladder is removed it by surgery (cholecystectomy), but if calculations have gone to biliary ERCP can detect them and reach them with hooks, baskets or small balls that sweep the bile leaving it free. In some situations the ERCP is able to even destroy stones one by one, so they are caught and exerts pressure with force until they are powdered.
Stenosis of the biliary tract: stenoses of biliary tract are bottlenecks that occur in bile duct after inflammations and manipulations. They can be produced by surgery, but there are also diseases that cause them like gallstones, autoimmune diseases (such as sclerosing cholangitis) or different cancers that affect the area (the colangiosarcoma and pancreatic cancer). To solve the stenosis ERCP placed stents that dilate the biliary tract, these are a few small docks between the walls of the ducts, similar to those used in cardiology.
Sphincterotomy: bile separates from the small intestine by a valve which is called sphincter of Oddi. This sphincter is a circular muscle that opens and closes as needed or not the passage of content of the bile into the duodenum. To perform any procedure in the biliary tract (like the above) is necessary to make a cut that this sphincter open and allow passage to the final end of the endoscope, this is known as sphincterotomy. It could also solve local problems of the sphincter of Oddi, as obstructions which do not allow passage of the contents of the biliary tract.
Takes biopsies: some nearby organs to the biliary tract, pancreas or intestine, can be affected by malignant tumors of difficult access. Own bile duct have cancers such as cholangiocarcinoma, which only could reach it through surgery if it fails to be because with ERCP fairly remote areas are reached. Thanks to her we can take biopsies easily, obtaining the organ tissue cylinders to study.

ERCP preparation

If you are going to perform an Endoscopic Retrograde Cholangiopancreatography (Ercp) these are the issues that you must take into account:
Duration: the duration of the ERCP is variable. It can last from a few minutes to more than one hour. It usually lasts longer if complex techniques are performed.
Income: it may be necessary to enter the night before of the test. Sometimes you can come from home directly with previous recommendations. After ERCP usually will stay a few hours in observation, it is not usually necessary to enter the hospital for one night or longer.
Is necessary to be accompanied?: Yes, it is recommended to carry a passenger. It is a test not exempt of risks and is better that at the end there is someone to take home and be with you a few hours later.
Drugs: you should tell the doctor all the medicines that you take regularly, you will decide what interrupt and what keep. Sometimes the specialist will recommend you take medication that will help to carry out the test, such as omeprazole to protect the stomach, but should be assessed to each patient individually. Drugs that are usually stopped before perform you ERCP include the antiplatelet agents, such as aspirin or ibuprofen.
Food: have to stay in an empty stomach at least four hours prior to the test, although it is often recommended eight hours.
Clothes: you can go to the ERCP with the same clothes every day. You will be prompted that you take it off and they will put a hospital that is more comfortable and hygienic gown.
Documents: it is recommended to carry the personal medical history, although the doctor will already have it with him. Before undergoing the test you will sign the informed consent with which you agree to make yourself the technique and you will know the potential risks, which are rare. They will also you a series of basic pretest tests, such as an electrocardiogram or a blood analysis, take the results with you if you have taken them.
Pregnancy and breast-feeding: ERCP is contraindicated in these situations. If there is a minimal chance of being pregnant not you should submit to this test without confirming it, exposure to x-rays can cause damage to the proper development of the fetus. Normally the doctor carried out a pregnancy test prior to women who do not deny being pregnant, but you should report it.
Breastfeeding does not imply a direct contraindication, but it is preferable to avoid testing until the breast feeding period is complete unless it is strictly necessary to perform the test.
Contraindications: pregnancy is a contraindication for this test. It should not be if you have chronic kidney damage, since the radiocontrast can worsen it, although it is uncommon and you can prevent hydration and medication. People who have an active infection (gastroenteritis, cholecystitis or cholangitis) nor should undergo this test if it is not strictly necessary.

How ERCP

First, they explain why it is necessary to perform ERCP and will ask you if you are agree to submit yourself to it. If so you will be asked to sign the informed consent where you will read what is the test. They will give you an appointment that you submit to the test another day, but if it's an emergency situation you can if it decides to put you to the test directly, but it's a bit common.
To make you the proof may be required that you enter the night before or not. If you go directly in the morning you should not forget to remain in fasting eight hours earlier. Go to the quiet and accompanied, hospital with enough time to not have to stress yourself before the test. Before entering the room where the test you will be ask you that you change your clothes and give you a batin's hospital. Once inside you will see multiple monitors and a stretcher where you tumbarás on the left side, so leave free the area of the liver and bile duct.
Before starting the intervention you will you a sleeve on the arm to control blood pressure, several electrodes on the chest to control heart rate and a venous pathway on the other arm to inject you with sedative drugs that you relax. When you are sedated they will introduce you the endoscope through the mouth, it will pass the esophagus and the stomach and duodenum will be. You won't feel of Arcade or pain, just a slight feeling that you have something in your mouth and that swollen abdomen.
Upon reaching the duodenum the doctor look for sphincter of Oddi with the camera, so you can release air that dilate the duodenum. When you have found it will try to get through it and if necessary will perform a sphincterotomy allowing him to step. At various times are made with low radiation x-rays to see where is the endoscope.
When the endoscope is inside the bile will instil the radiocontrast. With it you will see the anatomy of the biliary tract and calculations, can be detected will be like shadows that do not let all the contrast. In the case of the stenosis also will be seen as the contrast may not pass well, but in this case the duct will be narrower.
Techniques carried out in bile duct will pass completely unnoticed for you. In no time you will notice nothing, in fact it is usual that you remember even after the test. When finished will withdraw the endoscope.
Finally, you will go to another room so that rest of the ERCP and keep you under surveillance awhile, there you will recover from sedation. It is normal that you feel heaviness in the stomach, as gases, and also some sore throat that can be in up to tres-cuatro days. When you recover you you can go home with, you can drive in any case. The week after the test you can not exercise or heavy lifting.

Complications of ERCP

Serious complications in the ERCP are not very frequent, but some minor complications are very common and are resolved on their own. Some of which may occur occasionally are:
Sore throat.
Discomfort, nausea and vomiting.
Flatulence.
Heartburn or burning.
Fainting and loss of consciousness.
Urticaria.
Alterations of blood pressure suddenly.
Allergic reaction to the x-ray contrast medium.
Perforation of intestine or bile duct.
Retention of urine.
Internal bleeding.
Pancreatitis.
In short, after an ERCP you have to worry about and go to the emergency room only if you present severe abdominal pain, bleeding in the stool or vomiting, nausea and vomiting, or fever.

The ERCP results

While ERCP can know the results. When the bile duct is clean there are well shaped edges, unobstructed or narrowness in the contrast. Because a diagnosis is possible at the time of the test, complex interventions that solve them in a direct and effective manner can also be.
At other times, the study should be more detailed. This happens mainly when suspected a tumor that affects the bile duct or the closeness and needed a biopsy that study under microscope for knowing its origin. In that case the ERCP does not solve the problem, but manages to expand the study to make decisions on treatment.
The most common is the gastroenterologist announce you the diagnosis and the results of the test just after making it, once it has passed you the sedation. But it will also be necessary to days after ERCP to have a consultation with the gastroenterologist. There it will detail you what were the final results of the test and will inform you a diagnosis and long-term treatment (if necessary).
Sometimes the test is indicated by another physician (internists, oncologists or surgeons), so the query and the result may be with them. In the consultation shall be verified also that everything went correctly and that your evolution was favorable.

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