What is therapeutic ERCP?

ERCP, or endoscopic retrograde cholangiopancreatography, is a procedure that studies the ducts that drain the pancreas and liver. The procedure is used to diagnose and treat conditions related to the bile ducts. Conditions or problems with the ducts can include leaks, cancer, inflammatory strictures, and gallstones. The ducts that drain the liver and gallbladder are referred to as biliary ducts or bile ducts. The duct that drains the pancreas is called the pancreatic duct. These ducts are joined before their drain into the bowel through an opening called the papilla. The sphincter of Oddi is the circular muscle that surrounds the papilla.

Diagnostic ERCPs can be performed to help diagnose certain conditions using contrast dyes and x-rays to obtain images of the ducts. Therapeutic ERCPs can be performed to allow treatment for certain conditions. Treatments such as a sphincterotomy, stone removal, stent placement, balloon dilation, and tissue sampling can all be done through an ERCP scope.

A sphincterotomy is a treatment that involves cutting the muscles around the ducts in order to enlarge the opening. To do this, a small wire or specialized catheter uses electrical currents to cut tissue. Because there are no nerve endings where the tissue is cut, the procedure should not cause the patient any discomfort. The cut is small, usually less than a half-inch, and allows the doctor to be able to perform several different treatments. A biliary sphincterotomy is often performed using this procedure, but the cut may also be made towards the pancreatic duct.

A common treatment, therapeutic ERCPs are also often performed to remove stones that have traveled into the bile ducts. Stones can be removed after a sphincterotomy is performed, enlarging the opening of the duct. Large stones may need to be crushed before they can be removed with a specialized basket so that smaller fragments may then be removed. Therapeutic ERCPs can also be performed to sample tissue, which can help to diagnose and treat certain conditions. There are several different techniques for sampling tissue, and the treatment is often used to determine if a narrowing of the duct is due to cancer.

Stents can also be placed to prevent blockages in narrowed areas of the bile ducts. Ducts can narrow due to scar tissue or tumors that block drainage. Stents can be made of metal or plastic. They may clog after several months, and new stents may need to be placed. Balloon dilation is another treatment that involves catheters fitted with dilating balloons that are placed in a narrowed part of the duct and stretch out the narrowed area. Temporary stents may also be placed during this treatment.

What is a therapeutic ERCP procedure like?

Patients should follow all of their doctor’s instructions and should not eat for six hours before the procedure. They should also inform the doctor of any medications or supplements they are currently taking and if they have any known allergy to contrast material or medications. Patients may need to take antibiotics before the procedure. An intravenous needle is placed in the arm so that the patients can receive medication during the procedure, and the patient will be given sedatives. The procedure is performed on an x-ray table, where the patient will receive any relevant treatment based on their diagnosis. The patient may be admitted to the hospital for the remainder of the day after their procedure. Patients should not operate a vehicle after their procedure but will be able to return to normal activities the next day.

Contact the specialists at Granite State Gastroenterology to learn more about therapeutic ERCP and ask if this procedure could help you treat your digestive disorders.