ERCP (Endoscopic Retrograde Colonoscopic Pancreatography) is the examination used to diagnose and treat diseases of the bile ducts and pancreas, with the help of endoscope and fluoroscopy. The bile ducts are the drainage system of the liver, through which bile is excreted into the duodenum, in an area called the Vater's gland.

The pancreatic duct drains the pancreatic fluids to the same place. Today, ERCP has replaced many of the surgical procedures that used to be done for biliary and pancreatic diseases.

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What are the indications for ERCP

The most common indication is the diagnosis and removal of stones through the bile duct (biliary cholelithiasis). Another indication is the treatment of jaundice when there is some form of stenosis in the bile ducts. In this case a small tube (stent) can be inserted through the endoscope to drain the bile into the small intestine.

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Preparation for surgery

ERCP is not an outpatient test but you will need to be admitted to hospital.

You should inform the doctor of any medications you are taking (e.g. blood thinners) so that the doctor can advise you if you need to stop taking them.The doctor will explain the nature of the examination and ask you to sign the consent form for the procedure.

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In the endoscopy room

The ERCP is done in an endoscopy room where there is a machine that takes X-rays.Before the examination, a venous catheter will be placed in your arm from where sedatives and analgesics will be administered.

You will be asked to lie face down on the bed of the X-ray machine

The special endoscope is then advanced by the doctor through the mouth up to the Vater's germ located in the duodenum. There the physician will attempt to pass some thin catheters into the bile duct or pancreatic duct. With the help of these catheters, contrast medicine is injected and the biliary tree and/or the pancreatic duct is visualized in the fluoroscopy. If necessary, an incision may be made in the Vater's germ (sphincterotomy) so that the stones can be removed or the stent can be placed.

Depending on the difficulty of the procedure, ERCP can take from half to one hour. During this time you will not be in any discomfort because you will be under the influence of sedative drugs (sedation). After the ERCP and depending on the condition you have, you will need to be hospitalised for at least 24 hours.

There are risks from the test

ERCP should always be performed by qualified personnel. There is a small percentage (up to 5%) where for mainly anatomical reasons it is not possible to complete the examination.

If complications do occur, they are usually mild. Serious complications are not very common. As with all operations, all measures are taken to avoid serious complications that may endanger the patient's life.

The most common complications are the following

• Pancreatitis (3-5%). This is inflammation of the pancreas and is usually mild. It is manifested by abdominal pain and vomiting a few hours later. In most cases the patient makes a full recovery in a few days
• Bleeding (1-2%). Can occur after a sphincterotomy and usually stops on its own
• Perforation. It is not a common complication and can occur either during the sphincterotomy or more rarely through the endoscope. Surgery may be required to treat it.
• Infections in the bile ducts (cholangitis). They are rare but can occur particularly in patients with pre-existing serious illnesses. They are usually treated with intravenous antibiotics.

Although deaths following the above complications have rarely been described (usually in patients with coexisting serious health problems), ERCP, when the indications are met, is the least risky of the surgical alternatives for biliary and pancreatic diseases.