Understanding ERCP
What is ERCP?
ERCP, otherwise known as Endoscopic Retrograde Cholangiopancreatography, is a minimally invasive advanced therapeutic endoscopic procedure that is used to diagnose and treat conditions that affect the bile ducts, liver, gallbladder and pancreas by using an endoscope. Most commonly this includes bile duct stones or bile duct blockages, (strictures) which may or may not require stenting, diagnosing and treating bile duct cancers, and pancreatic cancers. It is also useful in the management of surgical complications from gallbladder surgery, for example an injury to bile ducts during gallbladder surgery. It is performed using an endoscope which passes through the oesophagus and the stomach and reaches the second part of the duodenum (small bowel).
Due to my interest and subspecialization in advanced GI endoscopy and HPB (Hepatopancreatic biliary) medicine, Mater Private Network in Dublin is one of the two private hospitals in Dublin providing ERCP as a service on a full-time basis. Procedures are carried out under my supervision, supported by an excellent team of nurses, technicians and administrative staff.
Who needs an ERCP?
One of the most common signs and/or symptoms that will result in patients needing an ERCP is the development of jaundice (with or without pain), along with blood tests (liver tests and Bilirubin raised) and scans (either ultrasound CT and or MRI) that show a bile duct stone or a stricture (benign or malignant) within the bile ducts, or a mass from pancreatic head pressing on the bile ducts and resulting in jaundice.
Historically, cases such as this were treated with either open surgery or a laparoscopic procedure. In some scenarios, it would have resulted in death if the patient was not fit for surgery, especially in the case of elderly patients. But ERCP has no age limit and can be performed at any age; it can be life-saving in the case of sepsis in the bile ducts and liver due to such blockages.
ERCP is most commonly performed while patients are under light sedation. The exception are patients who cannot tolerate the procedure under sedation, in which case, general anaesthesia is given instead. The procedure is carried out in the main operating theatre or an endoscopy suite.
What is the recovery time?
The recovery time following an ERCP is just two hours, providing there are no complications. For most patients, this is a day case procedure, meaning they will come from home and are discharged on the same day with after care advice. Patients who already have an advanced diagnosis, i.e. cancer or infection in the bile ducts from bile duct stone(s), may be kept in hospital and the procedure is done while they are an inpatient.
What are the side effects & risks?
As with every medical procedure or medication, there may be some side effects. ERCP also comes with some risks and complications, however, the risk of complication is <5% in the vast majority of cases, and can range from 5%-20% depending on case by case basis depending on other co-morbidities. We discuss complications and risks carefully with each patient to identify which category they fall into, depending on their case.
On rare occasions patients may require a short hospital stay with medications +/- antibiotics or pain relief if complications occur. The most common complication is post ERCP pancreatitis (PEP). This is an inflammation (swelling) of the pancreas after ERCP as the pancreas and its pancreatic duct lies very close to the bile duct. The pancreatic duct (PD) opens through the same channel into the small bowel in almost every individual (with some exceptions). Due to the invasive nature of this procedure, internal bleeding can happen but most of the time the bleeding stops itself. If it requires endoscopic treatment, this will be done by the consultant during the procedure. In extremely rare cases it may require surgery to stop the bleeding.
Conclusion
ERCP offers transformative care for patients with digestive ailments, providing potential cures for several GI diseases. It allows patients to receive treatment on the same day, avoiding the need for traditional laparoscopic surgical procedures and extended hospital stays. This minimally invasive approach significantly reduces recovery times and associated risks. In addition to ERCP, Mater Private Network will soon offer Video Capsule Endoscopy, further enhancing our specialised gastroenterology services in 2024. We are excited to enhance our patients’ quality of life and demonstrate our commitment to advanced, innovative treatments for better patient outcomes.
Patients can be referred for ERCP by gastroenterologists, ED consultants, radiologists, general surgeons, and GPs. The procedure is covered by most major private health insurers.
To learn more about the procedure, please visit – https:// www.materprivate.ie/ourservices/digestive-diseases/ endoscopic-retrogradecholangiopancreatography-(ercp)