endoscopic retrograde cholangiopancreatography (ERCP)

^[1]^[2]^[3]^[4]

Indications

NPO after midnight prior to the procedure
allergies to iodine necessitate special considerations (see contrast agent)
administer rectal indomethacin 100 mg at the time of the procedure to prevent post-procedure pancreatitis

ERCP combines the use of X rays & an endoscope
visualization of the stomach & duodenum
injection of dye into the ducts in the biliary tree & pancreas so they can be visualized on X rays
use of a guidewire for cannulation of the bile duct during ERCP may diminish post-ERCP pancreatitis^[1]
patient lies on left side on an examining table in an X ray room
numb back of throat
sedation during the exam
- propofol or general anesthesia^[3]
turned on your stomach for pass a small plastic tube through the scope for injection of dye
X rays are taken as soon as the dye is injected
if the exam shows a gallstone or narrowing of the ducts, instruments can be inserted through the scope to correct the disorder
tissue samples (biopsy) can be taken for further testing
insert pancreatic stent if patient at risk for post-ERCP pancreatitis
ERCP takes 30 minutes to 2 hours

pancreatitis (common)
septicemia due to carbapenem-resistant Enterobacteriaceae
- design of the duodenoscop may impede effective cleaning ^[2]
bleeding
perforation of the duodenum
cardiopulmonary complications
mortality

↑ ^1.0 ^1.1 Cheung J et al. Guidewire versus conventional contrast cannulation of the common bile duct for the prevention of post-ERCP pancreatitis: A systematic review and meta-analysis. Gastrointest Endosc 2009 Dec; 70:1211. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19962504
↑ ^2.0 ^2.1 FDA MedWatch. Feb 19, 2015 Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes: FDA Safety Communication - Design May Impede Effective Cleaning. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm434922.htm
↑ ^3.0 ^3.1 Williams E et al. Updated guideline on the management of common bile duct stones (CBDS). Gut 2017 Jan 25; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28122906 <Internet> http://gut.bmj.com/content/early/2017/01/25/gutjnl-2016-312317
↑ NIDDK: Endoscopic Retrograde Cholangiopancreatography (ERCP) https://www.niddk.nih.gov/health-information/diagnostic-tests/endoscopic-retrograde-cholangiopancreatography