ERCP :

INDICATIONS OF ERCP

The indications of the ERCP procedure are listed below:

• Infections of the bile duct
• Blockage in the bile duct due to stones formed in the gallbladder
• Blockages or narrowing of the pancreatic duct
• Tumors or cancers of the bile duct or pancreatic duct
• Fluid leakage from the bile duct or pancreatic duct
• Acute pancreatitis
• Chronic pancreatitis
• Pancreatic pseudocysts
• Gallstones
• Trauma or surgical complications associated with bile duct or pancreatic duct.

CONTRAINDICATIONS OF ERCP

The contraindications of ERCP include:

• Visceral perforations
• Unstable cardiovascular, cardiopulmonary, or neurological status of the patient
• Bowel perforations
• Patient refusal to undergo the procedure
• Patient who is unfit for the procedure
• Esophageal stricture
• Gastric outlet obstruction
• Paraesophageal herniation
• Small bowel obstruction
• Esophageal diverticulum.

COMPLICATIONS ASSOCIATED WITH ERCP PROCEDURE

The complications that are associated with the ERCP procedure include:

• Infections of the bile duct or pancreatic duct
• Hemorrhage or excessive bleeding associated with the procedure
• Pancreatitis
• Perforation or damage to the bile duct or pancreatic duct during the procedure
• Complications due to anesthesia including respiratory or cardiac problems
• Tissue damage due to X-ray exposure
• Biloma-a collection of bile outside the bile duct
• Fever with chills
• Nausea and vomiting

STEPS FOR ERCP PROCEDURE

The ERCP procedure involves several steps that are important to understand. These steps include:

• After diagnosing the patient's condition, the doctor will advise them to undergo an ERCP procedure. Before the procedure, the patient will need to undergo several tests, including a complete blood count, liver function test, bleeding time, clotting time, and other laboratory investigations.
• The doctor will explain the procedure to the patient and their relative, including the associated risks in detail.
• The patient and their relative will need to sign a consent form.
• The doctor will ask the patient to discontinue certain medications a few days before the procedure. These may include blood thinners (anticoagulants) such as warfarin, aspirin, clopidogrel, apixaban, diabetic medications, etc.
• The patient will be advised to fast for 6-8 hours before the procedure
• The doctor may prescribe laxatives or give an enema to the patient on the night before the day of the procedure to empty the bowel.

• On the day of the procedure, the patient should bring someone with them. The procedure is done as a daycare procedure.
• The patient will be taken to the procedure room and an intravenous cannula will be placed on the hand or arm. The patient will be placed on their left side or belly on the x-ray table.
• The doctor will spray a sedation medicine into the back of the patient's throat to prevent gagging as the endoscope is passed down the throat. A mouth guard will be inserted into the patient's mouth to prevent biting down on the endoscope and protect their teeth.
• The ERCP procedure will be performed by a medical gastroenterologist or a gastroenterology surgeon. During the procedure, the doctor will insert a thin flexible tube with a tiny camera and light at one end of the tube. This tube will be passed from the mouth, into the esophagus, through the stomach, and into the bile duct. The other end of the scope will be connected to a monitor to visualize the internal organs.
• Air will be injected before the contrast dye is used. The doctor will take various X-ray images and then inject contrast dye into the pancreatic duct and take more X-ray images. If there is a narrowing of the bile duct or pancreatic duct, the doctor may place a stent and anchor if necessary. Throughout the procedure, the patient's vitals will be closely monitored.

• After the procedure, the patient will be moved to the recovery room for further management and care.
• The patient will be kept in the recovery room for a few hours. Once their condition is stable, the doctor will either discharge the patient or have them discharged the next day.
• The patient may experience mild discomfort, a sore throat, pain, nausea, or vomiting after the procedure.
• The patient should have regular follow-up appointments with their doctor after being discharged.

FREQUENTLY ASKED QUESTIONS

The ERCP procedure is performed by a gastroenterologist or a gastroenterology surgeon.

What is the anesthesia of choice for the ERCP procedure?

The ERCP procedure is often performed under general anesthesia or intravenous sedation.

Is the ERCP procedure painful?

The ERCP procedure is usually performed under anesthesia, so the patient won't feel any pain during the procedure. However, the patient might complain of uneasiness, nausea or vomiting, or mild pain in case of stent placement in the bile duct or pancreatic duct.

What is the prognosis of the ERCP procedure?

The ERCP procedure is considered to be the treatment of choice in case of bile duct obstruction or in case of other bile duct conditions. According to research studies, it is estimated that around 90% of success rate in children.

What alternative diagnostic procedures are available for ERCP?

Various other alternative diagnostic procedures are available for ERCP procedure, including:

• CT Cholangiography
• Endoscopic ultrasonography
• MR Cholangiography
• MRCP (Magnetic Resonance Cholangiopancreatography)

Is the ERCP procedure a major or complicated surgery?

The ERCP procedure is often done as a daycare procedure. The patient can often get discharged on the next day after the procedure, in case of no complications.

What do you mean by ERCP Stenting Procedure?

Stents are thin flexible devices made up of plastic or metal that can be used to widen the blockage or narrow passages. The ERCP procedure can help in placing a stent in the bile duct or pancreatic duct in case of blockage or narrowing of the duct. Stents can also be used to treat conditions where there is a leaking in the bile or pancreatic juice.

What is the cost of the ERCP procedure in India?

The cost of the ERCP procedure in India ranges from Rs. 20,000 to Rs. 80,000.

What is the duration of the ERCP procedure?

The duration of the ERCP procedure depends on various factors. On average, the procedure takes about 45 minutes to 1 hour.

What are the advantages of the ERCP procedure?

The advantages of the ERCP procedure are listed below:

• It helps in diagnosing abnormalities related to the pancreatic duct, common bile duct, liver, and gallbladder.
• Biliary endoscopic sphincterotomy
• Helps in removing stones that are obstructing the CBD and pancreatic duct
• Helps in placing the stent in the CBD (common bile duct) or in the pancreatic duct
• Removal of a stent from the bile duct.

What is the duration of recovery after the ERCP procedure?

The recovery period of the patient is based on the type of procedure the patient underwent and depends on the overall condition of the patient. The patient can get back to work within 5-6 days after the procedure. However, the patient might complain of sore throat, bloating in the abdomen, difficulty in swallowing, and mild pain in the abdomen for a duration of 3-4 days.