Therapeutic ERCP

All About Therapeutic ERCP

When undergoing an ECRP, various types of blockages can be identified and possibly treated on the spot. Here is what you need to know about therapeutic ECRP:

What is a therapeutic ERCP?

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a study of the ducts that drain the liver and pancreas. Ducts are drainage routes into the bowel. The ones that drain the liver and gallbladder are called bile or biliary ducts. The one that drains the pancreas is called the pancreatic duct. The bile and pancreatic ducts join together just before they drain into the upper bowel, about three (3) inches from the stomach. The drainage opening is called the papilla. The papilla is surrounded by a circular muscle, called the sphincter of Oddi.

Diagnostic ERCP is when X-ray contrast dye is injected into the bile duct, pancreatic duct or both. This contrast dye is squirted through a small tube called a catheter that fits through the ERCP endoscope. X-rays are taken during ERCP to capture pictures of these ducts, called diagnostic ERCP. However, most ERCPs are actually done for treatment and not just picture taking. When an ERCP is done to allow treatment, it is called therapeutic ERCP.

What treatments can be done through an ERCP scope?

Sphincterotomy

Sphincterotomy includes cutting the muscle that surrounds the opening of the ducts or the papilla. This cut is made to enlarge the opening so your doctor can look the ERCP scope at the duct opening. A small wire on a specialized catheter uses electric current to cut the tissue. A sphincterotomy does not cause discomfort, as you do not have nerve endings there. The actual cut is quite small, usually less than a 1/2 inch, and it allows for various treatments in the ducts.

Stone Removal

The most common treatment through an ERCP scope is removal of bile duct stones. These stones may have formed in the gallbladder and traveled into the bile duct or may form in the duct itself years after your gallbladder has been removed. After a sphincterotomy is performed to enlarge the opening of the bile duct, stones can be pulled from the duct into the bowel. A variety of balloons and baskets attached to specialized catheters can be passed through the ERCP scope into the ducts allowing stone removal.

Stent Placement

Stents are placed into the bile or pancreatic ducts to bypass strictures – narrowed parts of the duct caused by scar tissue or tumors that cause blockage of normal duct drainage. There are two types of stents that are commonly used. The first is made of plastic and looks like a small straw that can be pushed through the ERCP scope into a blocked duct to allow normal drainage. The second type of stent is made of flexible metal wires that springs open to a larger diameter than plastic stents. Metal stents are permanent while plastic stents are easily removed at a repeat procedure. Your doctor will choose the best type of stent for your problem.

Tissue Sampling

One procedure that is commonly performed through ERCP is taking samples of tissue from the papilla, bile or pancreatic ducts. Tissue samples can help decide if a stricture, or narrowing, is a cancer. If the sample is positive for cancer it is very accurate.

What can you expect before, during, and after a therapeutic ERCP?

You should not eat for at least six hours before the procedure. Tell your doctor about medications that you take regularly and whether you have any allergies to medications or contrast material.

You will have an intravenous needle placed in your arm so you can receive medicine during the procedure. You will also be given sedatives that will make you comfortable during the ERCP. Some patients require antibiotics before the procedure. The procedure is performed on a X-ray table, and after complete, you will go to a recovery area until the sedation effects reside. You should not drive a car for the rest of the day, although most patients can return to full activity the next day.

ASGE – The Source for Colonoscopy and Endoscopy