Endoscopic Retrograde Cholangiopancreatography (ERCP) is a specialized procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions affecting the bile ducts, pancreatic ducts, and gallbladder. ERCP allows for both visualization and intervention, making it a valuable tool in managing biliary and pancreatic disorders.

Indications for ERCP

ERCP is typically recommended for:

1. Diagnosis:
   • Bile duct stones (choledocholithiasis).
   • Tumors or strictures in the bile or pancreatic ducts.
   • Chronic pancreatitis or bile duct injuries.
2. Treatment:
   • Removing bile duct stones.
   • Placing stents in narrowed or blocked ducts.
   • Dilating strictures.
   • Treating bile leaks.

Procedure Steps

1. Preparation:

   • Fasting: The patient must fast for at least 6–8 hours before the procedure to ensure an empty stomach.
   • Medication Review: Blood-thinning medications may need to be temporarily discontinued. Antibiotics may be given to prevent infection.
   • Informed Consent: The doctor explains the procedure, risks, and benefits.

2. Sedation or Anesthesia:

   • The patient is given sedation or anesthesia for comfort and relaxation during the procedure.

3. Insertion of the Endoscope:

   • The patient lies on their side or stomach.
   • A side-viewing endoscope (duodenoscope) is gently passed through the mouth, esophagus, stomach, and into the duodenum (the first part of the small intestine).

4. Cannulation of the Ducts:

   • A small catheter is guided through the endoscope to access the bile or pancreatic ducts via the ampulla of Vater.
   • A contrast dye is injected into the ducts to visualize them on X-ray.

5. Diagnosis and Intervention:

   • The doctor examines the ducts for blockages, stones, strictures, or other abnormalities.
   • If needed, therapeutic procedures are performed:
     • Stone Removal: Stones are extracted using a basket or balloon.
     • Stent Placement: Plastic or metal stents are inserted to keep ducts open.
     • Stricture Dilation: Narrowed areas are widened using balloon dilation.
     • Sphincterotomy: The sphincter muscle is cut to facilitate stone removal or duct drainage.

6. Completion:

   • The endoscope is gently withdrawn, and the procedure is complete.
   • ERCP typically takes 30–90 minutes, depending on the complexity.

Post-Procedure Care

1. Recovery:

   • The patient is monitored in a recovery area until the sedative effects wear off.
   • Mild bloating or throat discomfort may occur but usually resolves quickly.

2. Diet:

   • Patients are typically instructed to resume a liquid or soft diet initially, progressing to a regular diet as tolerated.

3. Activity:

   • Rest is advised for the remainder of the day, and driving or operating machinery is prohibited.

4. Follow-Up:

   • The doctor discusses the findings and any further treatment required.
   • Biopsy or tissue sample results, if taken, are usually available within a few days.