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Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used mainly to treat conditions that affect the bile ducts and pancreatic ducts. These are small tubes that carry digestive fluids into the small intestine. A doctor who specializes in the digestive system, called a gastroenterologist, performs ERCP. The procedure also may be used to help diagnose some conditions.
ERCP is different from a standard upper endoscopy. Both procedures use a thin, flexible tube with a tiny camera. This tube, called an endoscope, passes through the mouth. An upper endoscopy looks at the esophagus, stomach and first part of the small intestine. ERCP uses an endoscope and X-rays to examine and treat the bile ducts and pancreatic ducts.
During ERCP, the endoscope is used to reach the opening of the bile ducts and pancreatic ducts in the small intestine. Contrast material is injected into the ducts. The X-ray images help the doctor find areas that may need treatment and then guide the treatment.
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Your healthcare professional may recommend ERCP to treat a condition that affects a bile duct or pancreatic duct. ERCP also may be used to collect cells or tissue to help diagnose certain conditions.
Sometimes magnetic resonance cholangiopancreatography (MRCP) is done before ERCP. MRCP is a special type of MRI that creates images of the bile ducts and pancreatic ducts. It can help find conditions that affect the ducts, but it can't be used to treat them. If the images show a condition that needs treatment, your healthcare professional may suggest ERCP.
A healthcare professional may recommend ERCP to:
- Remove stones from the bile ducts or pancreatic ducts.
- Open a bile duct or pancreatic duct that is narrowed or blocked.
- Place a small tube called a stent to keep a duct open.
- Help treat a bile duct infection caused by a blockage.
- Treat a leak in a bile duct or pancreatic duct.
- Collect cells or tissue from a narrowed or blocked bile duct for testing.
Bile duct stones
Gallstones form in the gallbladder. Sometimes a gallstone leaves the gallbladder and becomes stuck in the common bile duct. Stones in the common bile duct are called common bile duct stones, or choledocholithiasis. ERCP can remove these stones so bile can drain.
The doctor may make a small cut in the opening of the bile duct to help remove a stone. This is called a sphincterotomy. A small balloon can then be used to sweep the stone from the duct. This is called a balloon sweep. A small basket also can be used to remove the stone.
If your gallbladder is still in place, your healthcare team may recommend surgery to remove it after the bile duct stone is treated.
Narrowed or blocked ducts
Inflammation, scar tissue, stones or cancer can narrow or block a bile duct or pancreatic duct. A doctor may use ERCP to open the narrowed or blocked area so fluid can drain. A small tube called a stent may be placed to keep the area open.
A blocked bile duct can cause yellowing of the skin and eyes, called jaundice. Opening the blockage or placing a stent can allow bile to drain and help relieve jaundice.
ERCP also may be used to treat stones, leaks or narrowed areas in the pancreatic duct. These problems can occur with conditions such as pancreatitis. A stent may be placed to help pancreatic fluid drain into the small intestine.
Cancer
ERCP may be used to collect cells or tissue from a narrowed bile duct to test for cancer. Endoscopic ultrasound, (EUS) may be used with ERCP when cancer is suspected. EUS uses sound waves to create detailed images of the pancreas, bile ducts and nearby tissues. It also can be used to collect tissue for testing. Sometimes EUS and ERCP are done during the same visit.
Pancreatic cancer and bile duct cancer can narrow or block a bile duct. If this happens, the doctor may place a stent across the narrowed or blocked area to help bile drain.
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المخاطر
ERCP can cause complications. Your risk depends on your overall health, the reason for the procedure and what is done during ERCP.
Possible complications include:
- Pancreatitis. This is swelling and inflammation of the pancreas. Pancreatitis is the most common complication of ERCP. It occurs in about 5% of people who have ERCP. Most cases are mild, but some can be serious.
- Bleeding. Some treatments done during ERCP require a small cut called a sphincterotomy. Bleeding is more likely when a sphincterotomy is done.
- Infection. An infection can occur in the bile ducts or gallbladder. An infection of a bile duct is called cholangitis. It can be serious and needs prompt treatment.
- A tear in the digestive tract. A tear can occur in the digestive tract or a duct during ERCP. It may require treatment in the hospital and, in some cases, surgery.
- A reaction to sedation or anesthesia. ERCP is usually performed with sedation or general anesthesia. The type used depends on your overall health and the reason for the procedure. Reactions can occur, but the risk is low.
Your care team takes steps to lower the risk of complications. Certain medicines, fluids given through a vein or a temporary pancreatic stent may be used to lower the risk of pancreatitis. Antibiotics may be used in some people to lower the risk of infection.
Your care team also checks you during and after ERCP for signs of complications.
كيف تستعد؟
Your healthcare team gives you specific instructions to prepare for ERCP. You may be asked to:
- Fast before ERCP. Your healthcare team tells you when to stop eating and drinking before the procedure. This helps make sure your stomach is empty.
- Change how you take certain medicines. Some medicines, including blood thinners, may need to be stopped or changed before ERCP. Blood thinners can raise the risk of bleeding during certain treatments. Your healthcare team tells you how to take your medicines before the procedure.
Tell your healthcare team about all the medicines and supplements you take.
Plan ahead for recovery
You may receive sedation to help you relax during the procedure. Or you may receive medicine that puts you into a sleeplike state during the procedure. This is called general anesthesia.
Sedation or general anesthesia can make you sleepy, slow your reactions and make it harder to think clearly. If you go home the same day as the procedure, arrange for someone to drive you home. Rest and take the remainder of the day off from work or school. Do not drive or take public transportation.
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ERCP usually doesn't require an overnight hospital stay. Many people go home the same day. How long the procedure takes depends on the treatment you need.
Before the procedure
Your healthcare team reviews what to expect during ERCP and answers your questions.
You receive medicine in a vein to keep you comfortable during the procedure. Depending on the medicine used, you may feel relaxed and drowsy or be in a sleep-like state. In some cases, you also may receive antibiotics to help prevent infection.
During the procedure
You lie on an X-ray table. Your healthcare team checks your breathing, blood pressure, heart rate and other vital signs throughout the procedure.
The doctor guides a thin, flexible tube called an endoscope through your mouth and into the first part of your small intestine. The endoscope does not block your breathing. A tiny camera on the endoscope helps the doctor find the opening of the bile ducts and pancreatic ducts.
The doctor passes small tools through the endoscope to treat the ducts. Contrast material is injected into a duct to make it visible on X-rays. The X-ray images help guide treatment.
What happens next depends on the treatment you need. The doctor may remove stones, open a narrowed or blocked duct, place a stent, or collect cells or tissue for testing.
ERCP usually takes about an hour. It may take more or less time depending on the treatment you need.
After the procedure
After ERCP, you go to a recovery area while the sedation or anesthesia wears off. Your healthcare team checks you for signs of complications. You may stay in the recovery area for 1 to 2 hours or longer. Some people need to stay in the hospital overnight.
You may feel bloated or have gas pains, nausea or a mild sore throat after ERCP. These symptoms usually get better within a day.
Follow your healthcare team's instructions about eating and drinking, medicines, and activity after ERCP.
Seek emergency medical care if you have:
- New, different or ongoing belly pain.
- Ongoing nausea or vomiting.
- Blood in your vomit.
- Black, tarry stools.
- Neck or chest pain.
- A fever of 100.4 Fahrenheit (38 Celsius) or higher.
Signs of a bile duct infection
A bile duct infection, called cholangitis, is a possible complication of ERCP. Call your healthcare team right away if you have signs of cholangitis. These may include:
- Shaking that you can't control.
- Dark urine or light-colored stools.
- Yellowing of the skin or whites of the eyes, called jaundice.
- Pain in the upper-right part of the belly.
النتائج
After ERCP, your healthcare professional talks with you about what was found and any treatment that was done. If cells or tissue were collected for testing, those results may take longer.
Your healthcare team tells you how to get your results and whether you need follow-up care.
التجارب السريرية
استكشِف دراسات مايو كلينك حول الاختبارات والإجراءات المخصصة للوقاية من الحالات الصحية واكتشافها وعلاجها وإدارتها.