Endoscopic Retrograde Cholangiopancreatography (ERCP), It's What You Should Know

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ERCP (endoscopic retrograde cholangiopancreatography) is an action procedure for diagnosing and treating disorders or disorders that occur in the pancreas, bile ducts, and gallbladder. ERCP is a combination of two types of examination, namely endoscopy and X-ray photograph.

The ERCP procedure allows doctors to take pictures and see the conditions of the bile ducts and pancreas in more detail. This procedure can also provide important information that can not be obtained with other types of diagnostic checks, such as ultrasound, CT scan, or MRI.

ERCP procedure is done with the help of endoscope tool, which is thin and elastic hose equipped with camera and lamp at the end. This device will be inserted through the patient's mouth, through the esophagus, then into the stomach and intestines 12 duodenum, precisely at the end of the bile ducts and pancreas (vein papilla). The guidewire and catheter will then be inserted into the bile ducts or pancreas to enter contrast that is useful for making detailed images when X-rays are done.

The ERCP procedure may be accompanied by treatment measures, such as removing gallstones in the bile ducts or treating channel narrowing due to tumors causing a buildup of pancreatic fluid or bile.

Indications of Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is commonly used to diagnose a variety of disorders that occur in the bile ducts or pancreas, among others:

• Choledocholithiasis (bile duct stones).
• Acute pancreatitis.
• Chronic pancreatitis.
• The pancreas divisum, a pancreatic disorder that causes the pancreas ducts to fail to coalesce during its development, so that the pancreas has two separate channels.
• Pancreatic cancer or bile duct cancer (cholangiocarcinoma).
• An oddi sphincter disorder, the muscle valve that controls the flow of bile and pancreatic fluids.
• Trauma or complications of surgery that occur in the bile ducts and pancreas.

In addition, ERCP is also used as a treatment measure against various medical disorders that occur in the bile ducts or pancreas. Treatment measures include:

1.     Dilate the channel of the pancreas or bile that has narrowed.

2.     Remove or destroy the stones of the bile ducts.

3.     Open the sphincter oddi that closes (sphincterotomy).

Endoscopic Retrograde Cholangiopancreatography (ERCP) Warning.

There are several conditions that cause the patient can not undergo ERCP procedure, among others:

• Pregnant women. The doctor will use other procedures to protect the fetus from radiation dangers of X-rays used in the ERCP procedure.
• Patients have undergone gastrointestinal surgery which causes a closed channel in the bile system.
• New patients undergo a procedure that uses a barium contrast agent. The contents of barium in the intestine may interfere with the ERCP procedure.
• Patients suffer from abnormalities or disorders of the esophagus, stomach, or duodenum, causing ERCP procedures to be difficult.
• The patient has an unstable heart and nervous condition.

Before Endoscopic Retrograde Cholangiopancreatography (ERCP)

Before undergoing ERCP procedures, the doctor will explain in detail about the stages of the procedure to be passed patients, goals, and the risk of possible complications. Furthermore, the doctor will provide a form for the patient to sign, as a statement that the patient has understood the procedure to be performed and agrees to undergo the procedure.

Furthermore, there are some things that the patient needs to do before undergoing ERCP procedures, among others:

1.     Tell your doctor if you are pregnant. X-ray radiation exposure can cause disturbance to fetal condition.

2.     Tell your doctor if you have allergies or are sensitive to certain drugs, anesthesia, contrast dye, iodine, or latex.

3.     Tell your doctor if you have heart or lung problems, kidney disease, or have had dialysis.

4.     Tell your doctor if you have a heart valve disorder or use an artificial heart valve. Your doctor may give you antibiotics before undergoing the procedure.

5.     Tell your doctor if you have diabetes or have a treatment with insulin. The doctor will advise the patient to increase the dose of insulin before undergoing the ERCP procedure. Patients are also encouraged to take diabetes medicines for use after undergoing the procedure.

6.     Tell your doctor if you have a history of clotting disorders or are taking blood-thinning medications (anticoagulants) and aspirin. The doctor will ask the patient to stop taking the medication for some time before the procedure.

7.     Tell your doctor about medicines and herbal products being consumed.

Doctors will also recommend a few things to patients before undergoing ERCP procedures, among others:

• Fasting for 8 hours before undergoing ERCP procedure. The doctor may advise the patient to undergo a special diet for 1-2 days before the procedure.
• The doctor will encourage the patient to be accompanied by family members during and after the procedure, and to take the patient home.
• Patients will be asked to remove all objects or jewelry that may interfere with or affect the X-ray image before undergoing the procedure.

Endoscopic Retrograde Cholangiopancreatography (ERCP) Procedure

ERCP procedures may be performed on an outpatient or as part of an inpatient examination. This procedure takes 15 minutes to more than 1 hour depending on the patient's condition and the purpose of the procedure. The steps of ERCP procedure are as follows:

• Step 1: Get started.

1.     The patient will be laid on an X-ray table with a sloping posture.

2.     An oxygen saturation meter will be placed on the patient's finger to monitor oxygen and heart rate.

3.     The oxygen hose is placed in the patient's nostrils to assist in the intake of oxygen into the body.

4.     Needles and intravenous tubes are placed in the patient's arm or arm to pass the tranquilizer.

5.     The mouth buffer will be placed between the upper and lower teeth to protect the teeth and so the patient does not bite the endoscopic apparatus.

• Step 2: Anesthesia.

1.     The doctor will inject tranquilizers and painkillers into the blood vessels via an IV. This drug will make the patient more calm and sleepy, but not make the patient asleep.

2.     The doctor will spray the anesthetic into the throat. This medicine will cause the numbness of the throat and prevent the patient from choking when the endoscope is inserted into the throat

• Step 3: Endoscopy.

1.     After the patient's throat is numbed, a gastroenterologist in the gastrointestinal consultant (KGEH) will insert the endoscope through the mouth, down the throat, then into the stomach, and into the duodenum out of the bile ducts and pancreas ducts.

2.     The doctor will pump air into the stomach through the endoscope, making it easier for the device to enter the duodenum and see the hole.

• Step 4: Reality and contrast.

1.     A small tube or catheter is inserted through the endoscope to the hole, and ends in the pancreas and gallbladder.

2.     The contrast dye will be injected through the catheter, so the bile ducts and pancreas can be seen more clearly at the time of the X-ray

• Step 5: X-rays. After the contrast is injected, X-rays will be done. X-rays are able to show in detail the bile ducts and pancreas, as well as possible abnormalities, such as narrowing of channels that may be caused by gallstones or tumors.

• Step 6: Fluoroscopy. In some cases, abnormalities or disorders can be treated and treated during ERCP procedures with fluoroscopy techniques. Fluoroscopy is a combination of the use of X-rays and contrast dyes injected through a catheter, which can produce a series of real images and detail the condition of the inside of the bile ducts and pancreatic ducts, over time, so that it looks like a video. Some possible treatment actions include:

1.     Sphincterotomy. The act of cutting the sphincter (valve of the muscle) at the opening of the bile duct and the pancreas to remove an object that clogs the canal, eg gallstones.

2.     Stent placement. A stent is a plastic tube that can be placed in the bile ducts or a narrowed pancreas to keep the bile duct or pancreas open, allowing bile or pancreatic fluid to flow

After Endoscopic Retrograde Cholangiopancreatography (ERCP)

After the ERCP procedure is completed, the patient will be placed in the recovery room for 1-2 hours until the effects of sedatives and anesthesia are lost. The doctor will also monitor or observe the patient's condition during the recovery process.

After the doctor confirmed that the patient's blood pressure, heart rate, and breathing were stable, the patient was allowed to go home. Under certain conditions, patients may be advised to stay overnight in the treatment room.

Patients may feel dizzy and have difficulty concentrating after undergoing ERCP procedure. Make sure the patient is accompanied by a family member to deliver home and accompany the patient to rest at home at least 24 hours after the procedure

Doctors may prescribe drugs to reduce the risk of pancreatitis, and encourage patients to avoid heavy activities, and eat mild foods until the patient's swallowing function returns to normal. The patient can return to normal activity the next day.

ERCP examination results are usually available shortly after the procedure is completed. The doctor will discuss the results of the examination after the patient is fully aware. If the ERCP result shows that the patient needs medical treatment, then the doctor will determine the type of treatment to be performed next.

Endoscopic Retrograde Cholangiopancreatography (ERCP) Complications

ERCP is a very safe check procedure. Some patients may experience mild side effects after undergoing ERCP, including:

• Tired or sleepy due to sedative effects.
• Mild sore throat.
• Bloated.

Call your doctor immediately or go to the nearest hospital for emergency treatment if you experience any of the following symptoms:

1.     Fever

2.     Shivering

3.     Nausea and vomiting

4.     Persistent cough (persistent)

5.     Chest pain

6.     Abdominal pain is great

7.     Bleeding (vomiting blood or bloody bowel movements)

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In addition, there are several risks of complications that may occur after the ERCP procedure, among others:

• Inflammation of the pancreas (pancreatitis), occurs when the pancreas is irritated by the use of special dyes used when shooting with X-rays.
• Bile duct infections (cholangitis), can occur when the bile ducts do not flow well.
• Bleeding, commonly occurs when the sphincter (ring-shaped muscle valve) in the vein papilla is cut (sphincterotomy). Bleeding is usually mild and can heal by itself. If bleeding occurs during the procedure, then the doctor will treat it with endoscopic techniques, including placing clips or epinephrine injections.
• Perforation (rupture or tear), which can occur in the esophagus, stomach, small intestine or bile. This condition can be mild and will heal by itself, or is severe, requiring surgery to repair it.
• Aspiration, can occur when the food from the stomach rises back into the esophagus, then into the respiratory tract, causing the patient difficulty breathing. This risk can be decreased by fasting for several hours before undergoing ERCP procedures.
• Allergic reactions to tranquilizers or drugs.