Makindo Medical Notes

Magnetic Resonance Cholangiopancreatography (MRCP) is increasingly becoming the preferred diagnostic tool for detecting gallstones in the common bile duct (CBD), while Endoscopic Retrograde Cholangiopancreatography (ERCP) is primarily used for therapeutic interventions, such as sphincterotomy and stenting.

About ERCP

• ERCP combines upper gastrointestinal (GI) endoscopy and X-rays to examine the bile ducts, pancreatic ducts, and gallbladder.
• It not only provides diagnostic information but also allows for treatment of issues related to the bile and pancreatic ducts.

ERCP Procedure

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure that can be both diagnostic and therapeutic, involving the use of an endoscope to visualize the GI tract and inject contrast dye into the bile and pancreatic ducts. This allows for detailed X-ray images and interventions if needed.

Indications for ERCP

• Detect gallstones in the biliary system, especially the common bile duct (CBD).
• Remove stones trapped in the biliary system.
• Diagnose sclerosing cholangitis or strictures in the biliary tree.
• Identify and treat pancreatic or biliary cancers.
• Place stents to facilitate bile drainage in cases of obstruction.
• Perform a sphincterotomy to cut the lower CBD sphincter, allowing stones to pass.
• Stent the pancreatic duct if necessary.

ERCP Procedure Steps

• The patient fasts before the procedure and is typically sedated.
• An endoscope is passed through the mouth, esophagus, and stomach to reach the second part of the duodenum.
• The biliary duct is cannulated, and contrast dye is injected to outline the bile ducts on X-ray. This helps to identify stones, strictures, or tumours.
• The operator can perform biopsies, remove stones, place stents, or perform a sphincterotomy to open the lower CBD.

Example: Large Stone in the Common Bile Duct (CBD)

In cases where large stones are present in the CBD, ERCP is an effective method for removing these stones and ensuring bile flow is restored.

Procedure Duration

• An ERCP procedure typically lasts between 1 to 2 hours.
• Patients usually receive sedation for comfort during the procedure.

Pre-procedure Checklist

• Check the patient’s clotting profile (INR and platelet count) to ensure safe performance of the procedure, particularly if any interventions like a sphincterotomy are planned.

Potential Complications

• Respiratory complications related to sedation.
• Perforation of the gastrointestinal tract.
• Gastrointestinal bleeding, which can be severe in approximately 2% of cases.
• Acute pancreatitis, occurring in about 5% of cases.
• Cholangitis (infection of the bile ducts).
• Tissue damage from prolonged X-ray exposure.

References

• Patient Information Sheet on ERCP