Identify Blockages with an Endoscopic Procedure

When it is suspected that your bile or pancreatic ducts may be more narrow than usual or may be blocked by something, an ERCP (Endoscopic Retrograde Cholangiopancreatography) procedure is the endoscopic procedure that may be necessary to identify what is causing the issue. There are a variety of issues that can be associated with these ducts being interrupted, so it is important that you get professional help in identifying the source of the issue.

What is ERCP (Endoscopic Retrograde Cholangiopancreatography)?

ERCP is a specialized technique used to view the ducts (drainage routes) of the liver, gallbladder, and pancreas (the drainage channels from the liver are called bile ducts or biliary ducts).

An endoscope (flexible thin tube) is passed through the mouth, esophagus and stomach into the duodenum (first part of the small intestine). After the common opening to ducts from the liver and pancreas is identified, a catheter (narrow plastic tube) is passed through the endoscope into the ducts. Contrast material (dye) is then injected into the ducts (pancreatic or biliary) and X-rays are taken.

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What to expect for ERCP.

During ERCP, medication is given through an IV to help you feel relaxed for the duration of the procedure. To make the procedure more comfortable, your gastroenterology doctor will also spray a numbing spray into the back of your throat to. A small, plastic mouthpiece is then inserted to help your mouth stay open during the procedure. The doctor will then insert the endoscope until it reaches your digestive tract. A small amount of air may be sent through the endoscope into your duodenum to allow more room for the procedure, which may make you feel full. Once your doctor finds the opening where the pancreatic and bile duct is located, they will inject a small amount of dye that may cause a small amount of discomfort or nausea that will not last long. You may then be asked to change positions based on what is found during the procedure and what doctors require for further diagnoses.

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Common questions and important information regarding ERCP.

We at Kalamazoo Gastroenterology Hepatology know that when our patients know more about the procedure they are to take, that they often feel more comfortable going into it. So, we like to provide important information and answers to our most asked questions to help individuals feel safe going into the procedure, or figure out if ERCP is something they should consider.

ERCP is used when it is suspected a person’s bile or pancreatic ducts may be narrowed or blocked due to:
• Tumors
• Gallstones that form in the gallbladder and become stuck in the duct
• Inflammation due to trauma or illness, such as pancreatitis—inflammation of the pancreas
• Infection
• Valves in the ducts, called sphincters, that won’t open properly
• Scarring of the ducts, called sclerosis
• Pseudocysts—accumulations of fluid and tissue debris

ERCP is a well-tolerated procedure when performed by doctors who are specially trained and experienced in the technique. Although complications requiring hospitalization can occur, they are uncommon. Complications can include pancreatitis (inflammation of the pancreas), infections, bowel perforation and bleeding. Some patients can have an adverse reaction to the sedative used. Sometimes the procedure cannot be completed for technical reasons.
Risks vary, depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems. Patients undergoing therapeutic ERCP, such as for stone removal, face a higher risk of complications than patients undergoing diagnostic ERCP. Your doctor will discuss your likelihood of complications before you undergo the test.