Endoscopic retrograde cholangiopancreatography is one of the most effective diagnostic methods, which is aimed at the investigation of the bile duct and pancreas. The technique combines the use of radiological and endoscopic instruments. For the first time the technique was applied in 1968.
Today, thanks to the use of high-tech equipment, it is possible to place an accurate diagnosis with a high degree of reliability and to prescribe treatment in a timely manner.
When the endoscope passes through the esophagus, stomach and intestines, the technique makes it possible to additionally ascertain the presence of pathologies of these organs. Often the result is the identification of fistulas, neoplasms and ulcerative lesions.
ERCP is used to identify and clarify the diagnosis of the following problems:
- Mechanical jaundice. It arises because of the stenosis of the duodenal papilla or when the choledoch is narrowed. It allows to reveal the presence and complication of cholelithiasis. Symptomatic pathology includes pain in the right upper quadrant, which gives into the arm and other areas of the body.
- Cancerous tumors of the pancreas. If ultrasound and MRI do not give a clear picture, then ERCP takes place. It allows to exclude false results.
- Chronic pancreatitis. The method establishes the characteristics of the inflammatory process, allows the initiation of therapy until the onset of degenerative changes.
- Pancreatic fistulae. They often appear after external drainage of the pancreatic cysts. The method allows to determine the nature of the fistulous course, as well as the amount and composition of pancreatic juice.
It is not possible to conduct a study with epilepsy, acute heart failure and myocardial infarction. The method is replaced with another if the person has intolerance of contrast preparations.
- Pancreatic necrosis( fat, haemorrhagic).
- ERCPG induced pancreatitis in history.
- Acute phase of pancreatitis or exacerbation of chronic form.
The doctor will offer to postpone the examination and when taking anticoagulants and during pregnancy. In the first case, the dose of the drug is first adjusted or replaced by similar means.
Preparing for the
procedure Before the procedure, you must stop eating and drinking for 12 hours. This guarantees emptiness of the stomach and upper intestine. The day before, the doctor is provided with a complete list of drugs that have been used.
In advance, if there is an allergy to iodine, and also about the presence of chronic diseases of the digestive tract, heart and respiratory system.
Method of ERCPR
One of the directions of the successful procedure is the relaxation of the duodenum. This is achieved by administering drugs before the test or during the procedure. It is possible to use sedatives on the eve of the study.
To reduce pain, local anesthesia is also performed using an aerosol with lidocaine or the like.
At the very beginning of the study the patient is placed on the left side, having his left hand behind his back. This allows you to start a gastroscopy. After this, the endoscope moves to the duodenum. The person takes a position lying on his stomach. Hands can be located along the trunk or behind the back.
Revision of the gut and test introduction of contrast medium. Then, contrasting streaming systems and making radiographic shots with mandatory tracking of the evacuation of contrast medium is carried out. As the endoscope moves, air is supplied to expand the intestine.
Contrast substance is injected through the endoscope at the exit site of bile and ducts. Contrast makes it possible to make the channels visible for X-ray radiation.
If problems are found, the doctor can immediately remove them. For example, with sphincterometry, the shape and plastic of the common duct are corrected. The method makes it possible to remove stones or install a stent. The latter is understood as a special plastic element, which serves as an expander for stenosis.
Complications after endoscopic retrograde cholangiopancreatography
The most dangerous complications are:
- Pancreatitis. This is the most popular complication. For him, characteristic is the appearance or intensification of pain in the abdomen, an increase in serum amylase by 3 or more times. In this case, surveillance is assigned in a hospital setting.
- Bleeding. Usually occurs with simultaneous carrying out of medical manipulations. This can lead to a strong decrease in hemoglobin and the need for blood transfusion. The risk factors for the development of such complications include small sizes of the mouth of the OBD and problems with coagulability of blood.
- Perforation. The factors of breakthrough risk include preliminary dissection and instrumental contrast insertion.
- Purulent complications. They appear in the presence of obstruction of the flow systems, for example, in cysts or stenoses.
After the procedure, less dangerous complications can occur that occur in other endoscopic methods of investigation. These include: allergies, conjunctivitis, aspiration pneumonia.
Mortality after the study reaches 0.1-0.2%. The average incidence of complications is 0.6-2.6% of cases.
ERCP is an operation that is most often performed. Its success depends on two components: the qualification of the doctor and the equipment. Therefore, patients are advised to carefully study the procedure before the procedure.
This technique is invasive. If there are alternative ways to diagnose, then preference is given to them.
According to the patients' feedback, one can understand that many people are recommended for rest throughout the day and are not allowed to drink alcohol for 24 hours more. When fever and chills occur, as well as the appearance of vomiting with blood, it is recommended to consult a doctor immediately.
The cost of the procedure depends on the doctor's qualifications, the equipment used and the actions during the study.
Video shows the procedure for extracting stones at ERCPH: