Endoscopic Retrograde Pancreatography

(ERCP)

<Investigations>

<Index>

 

 

 

Definition

-  Diagnostic +/- therapeutic imaging of the biliary tree, gall bladder & pancreatic ducts under image intensifier via duodenoscopic contrast injection

 

Rationale

-  Dx of hepatobiliary & pancreatic disease

 

Features

-  Endoscopic procedure

-  Allows direct visual inspection of bowel via duodenoscope plus x-ray imaging of biliary (+/- gall bladder) & pancreatic ducts via contrast injection

-  +/- stenting, sphincterotomy + stone removal, biopsy

 

Indications

-  Gall stones: cholecystitis

-  Biliary strictures/leaks & duct compression

-  Obstructive jaundice

-  Pancreatic Ca

-  Recurrent pancreatitis

-  Undifferentiated persistant or recurrent upper abdo pain

 

Request

-  Yellow slip to Endoscopy unit in person or fax 7331

-  As per endoscopy request

-  ERCPs require AXR prior

 

Procedure

-  Ensure no iodine allergies

-  U&E: renal function

-  Fasting for 6-8hrs prior

-  30min – 2hrs to perform

-  Throat anaesthetic spray

-  Sedation & analgesia

-  Pt left lateral decubitus

-  Duodenoscopy via oesphagus

-  Side viewing scope

-  Cannula into Ampula of Vater

-  Contrast injected into Ampulla + Image intensifier (II)

-  Sphincterotomy: stones >1cm

 

 

 

 

Complications

-  Pancreatitis 5-10% pts

-  Cholangitis

-  Bleeding

-  Duodenal perforation

-  Pain: abdo, left shoulder, left chest, back

-  Nausea & vomiting