Endoscopic Retrograde Cholangio-Pancreatography (ERCP) combines the use of a flexible, lighted scope (endoscope) with X-ray imaging to examine the ducts that drain the liver, gallbladder, and pancreas. The endoscope is inserted through the mouth and gently moved down the throat into the esophagus, stomach, and duodenum until it reaches the point where the ducts from the pancreas (pancreatic ducts) and gallbladder (bile ducts) drain into the duodenum.

ERCP can treat certain problems identified during the procedure. If an abnormal growth is found, instruments such as biopsy forceps or brushes may be inserted through the endoscope to collect samples for further testing (biopsy). If a gallstone is present in the common bile duct, the doctor can sometimes remove the stone with instruments inserted through the endoscope. A narrowed bile duct can be opened by inserting a small wire-mesh or plastic tube (called a stent) through the endoscope and into the duct.

ERCP is done to:

Evaluate suspected obstruction of the bile ducts
Remove stones from the common bile duct, which may already or later result in problems such as blockage (obstruction), infection of the bile ducts (cholangitis), or pancreatitis
Remove stones blocking the pancreatic duct
Open up a narrowed bile duct or pancreatic duct
Place a scaffolding known as a stent, to hold open a narrowed or blocked part of the bile duct or pancreatic duct
Perform drainage of a fluid collection adjacent to the pancreas
Obtain a tissue sample for further testing (biopsy)

ERCP is accepted worldwide as the procedure of choice, for the management of most of the clinical situations listed above.

How ERCP is conducted

Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is done by a doctor trained in endoscopy and with specific training in this procedure. This is usually a doctor who specializes in diseases of the digestive system (gastroenterologist). A thin, flexible video-endoscope is used.

ERCP is done in the hospital and usually takes between 30 and 60 minutes. The patient may have to stay overnight if certain treatments are performed during the procedure, or if it is done later in the day. Otherwise, the patient is often allowed to go home after the procedure. Resting after the procedure takes place in the recovery area for 1-2 hours.

ERCPs in NUH

The Endoscopy Centre at the National University Hospital is a tertiary endoscopy facility. Besides routine diagnostic and therapeutic Gastroscopy, Colonoscopy, Endoscopic Ultrasonography (EUS), and ERCP, we also perform specialist endoscopic procedures like Wireless Capsule Endoscopy, Balloon-Assisted Enteroscopy, Intragastric Balloon Placement, Confocal Endomicroscopy, Fine-Needle Aspiration or Injection under EUS, and Endoscopic Submucosal Dissection for the definitive treatment of very early cancers of the digestive tract.

Results of some of our key procedures have been audited and published in the international literature. Success cannulation rate at ERCP was 94%¹. This is comparable to international standards of 91%². The rate of all ERCP complications was less than 10%. Audits showed 4.4% in 2008 and 3.6% in 2009 (unpublished data). These compare very favourably with international multi-centre studies that quote an overall complication rate of 6.85%⁷. Despite being a tertiary endoscopic centre, our mortality of 10%³ in patients with upper gastrointestinal bleeding is equivalent to international standards of 10%^4-6.

Information is correct as at March 2010

Footnotes

Ong TZ, Khor JL, Selamat DS, Yeoh KG, Ho KY; Complications of endoscopic retrograde cholangiography in the post-MRCP era: a tertiary center experience; World J Gastroenterol; 2005 Sep 7;11(33):5209-12.
Schlup MM, Williams SM, Barbezat GO. ERCP: a review of technical competency and workload in a small unit. Gastrointest Endosc 1997;46:48-52.
Ong TZ, Yeoh KG, Ho KY.; Emergency endoscopy within 4 hours is an independent predictive factor for reduced mortality in patients presenting with high-risk upper GI bleeding; Gastrointestinal Endoscopy 2004; 59 (5): AB 162.
Freeman ML, Guda NM. Prevention of post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc 2004;59:845-64.
Yavorski RT, Wong RK, Maydonovitch C, Battin LS, Furnia A, Amundson DE. Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol 1995;90:568-73.
Vreeburg EM, Snel P, de Bruijne JW, Bartelsman JF, Rauws EA, Tytgat GN. Acute upper gastrointestinal bleeding in the Amsterdam area: incidence, diagnosis, and clinical outcome. Am J Gastroenterol. 1997 Feb;92(2):236-43.
Andriulli, A, et al, Incidence Rates of Post-ERCP Complications: A Systematic Survey of Prospective Studies, Am J Gastroenterol 2007, 102(8):1781-1788.

This material does not cover all information and is not intended as a substitute for professional care. Please consult with your physician on any matters regarding your health.

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