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Endoscopic Retrograde Cholangiopancreatography (ERCP)

A procedure that uses an endoscope to examine and x-ray the pancreatic duct, hepatic duct, common bile duct, duodenal papilla, and gallbladder.

PubMed Health Glossary
(Source: NIH - National Cancer Institute)

About ERCP

Endoscopic retrograde cholangiopancreatography is a procedure that combines upper gastrointestinal (GI) endoscopy and x rays to treat problems of the bile and pancreatic ducts. ERCP is also used to diagnose problems, but the availability of non-invasive tests such as magnetic resonance cholangiography has allowed ERCP to be used primarily for cases in which it is expected that treatment will be delivered during the procedure; see "How is ERCP performed?"

What is upper gastrointestinal (GI) endoscopy?

Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see and perform procedures inside the upper GI tract. The upper GI tract includes the esophagus, stomach, and duodenum - the first part of the small intestine.

What are the bile and pancreatic ducts?

Ducts are tubelike structures in the body that carry fluids. The bile ducts carry bile, a liquid the liver makes to help break down food. A group of small bile ducts - called the biliary tree - in the liver empties bile into the larger common bile duct. Between meals, the common bile duct closes and bile collects in the gallbladder - a pear-shaped sac next to the liver.

The pancreatic ducts carry pancreatic juice, a liquid the pancreas makes to help break down food. A group of small pancreatic ducts in the pancreas empties into the main pancreatic duct.

The common bile duct and the main pancreatic duct join before emptying their contents into the duodenum through the papillary orifice at the end of the duodenal papilla - a small, nipplelike structure that extends into the duodenum.

When is ERCP used?

ERCP is used when it is suspected a person's bile or pancreatic ducts may be narrowed or blocked due to

NIH - National Institute of Diabetes and Digestive and Kidney Diseases

What works? Research summarized

Evidence reviews

Carbon dioxide insufflation versus air insufflation during endoscopic retrograde cholangiopancreatography: a meta-analysis

Bibliographic details: Wu J, Hu B.  Carbon dioxide insufflation versus air insufflation during endoscopic retrograde cholangiopancreatography: a meta-analysis. Journal of Interventional Gastroenterology 2013; 3(1): 37-4224147227

A systematic review and economic evaluation of magnetic resonance cholangiopancreatography compared with diagnostic endoscopic retrograde cholangiopancreatography

Magnetic resonance cholangiopancreatography (MRCP) is an alternative to diagnostic endoscopic retrograde cholangiopancreatography (ERCP) for imaging the biliary tree and investigating biliary obstruction. MRCP is a purely diagnostic test with no therapeutic value. It does not have the small but definite morbidity and mortality associated with ERCP.

Accessing the bile duct by inserting a guidewire into the pancreatic duct to prevent inflammation of the pancreas after endoscopic retrograde cholangiopancreatography (ERCP)

To compare the effects of the pancreatic duct guidewire (PGW) technique with other endoscopic techniques for gaining access to the bile duct when access to the bile duct is considered to be difficult using traditional techniques.

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Summaries for consumers

Accessing the bile duct by inserting a guidewire into the pancreatic duct to prevent inflammation of the pancreas after endoscopic retrograde cholangiopancreatography (ERCP)

To compare the effects of the pancreatic duct guidewire (PGW) technique with other endoscopic techniques for gaining access to the bile duct when access to the bile duct is considered to be difficult using traditional techniques.

Endoscopic retrograde cholangiopancreatography versus intraoperative cholangiography for the diagnosis of common bile duct stones

The liver has various functions. Production of bile is one of these functions. The common bile duct (CBD) is the tube through which bile flows from the gallbladder (where bile is temporarily stored) into the small bowel. Stones in the CBD (CBD stones) can obstruct the flow of bile from the liver into the small bowel. Usually such stones are formed in the gallbladder and migrate into the CBD. Obstruction of the flow of bile can lead to jaundice (yellowish discolouration of skin and white of the eyes, and dark urine), infection of the bile duct (cholangitis), and inflammation of the pancreas (pancreatitis), which can be life threatening. Various diagnostic tests can be performed to diagnose CBD stones. Depending upon the availability of resources, these stones are removed endoscopically (a tube inserted into the stomach and upper part of small bowel through mouth; usually the case), or may be removed as part of the laparoscopic operation (key hole surgery) or open operation performed to remove the gallbladder (cholecystectomy; it is important to remove the gallbladder since the stones continue to form in the gallbladder and can cause recurrent health problems). If the stones are removed endoscopically, presence of stones is confirmed by endoscopic retrograde cholangiopancreatography (ERCP) (injection of dye into the CBD using an endoscope) before endoscopic removal of CBD stones. Alternatively, intraoperative cholangiography (IOC) (injection of dye into the biliary tree during an operation to remove the CBD stones, usually combined with an operation to remove gallstones) can be performed to detect CBD stones prior to operative removal of the stones. We performed a thorough search for studies that reported the accuracy of ERCP or IOC for the diagnosis of CBD stones. The evidence is current to September 2012.

No evidence to support or refute endoscopic retrograde cholangiopancreaticography (ERCP) with stenting in patients with malignant pancreaticobiliary diseases, awaiting surgery

Pancreatico‐biliary malignancy includes cancers of pancreas, ampulla, duodenum, and cholangiocarcinoma. There is significant morbidity and mortality related to surgery in these patients. Studies have claimed the beneficial role of biliary decompression, which can be performed via endoscopic retrograde cholangiopancreaticography (ERCP) with stent insertion pre‐surgically. The review found that pre‐surgical biliary stenting via ERCP did not improve the morbidity and mortality in patients with pancreatico‐biliary malignancy. Further evidence about its efficiency is needed.

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Terms to know

Bile Ducts
Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion.
Catheter
A thin, flexible tube that carries fluids into or out of the body.
Common Bile Duct
The tube that carries bile from the liver to the small intestine.
Common Hepatic Duct
A tube that carries bile from the liver. It starts where the right and left hepatic (liver) ducts join outside the liver. It ends where the cystic duct from the gallbladder joins it to form the common bile duct. It is part of the biliary duct system.
Duodenum
The first part of the small intestine that connects to the stomach.
Gallbladder
The organ that stores the bile made in the liver and that is connected to the liver by bile ducts. The gallbladder can store about 2 tablespoons of bile. Eating signals the gallbladder to empty the bile through the bile ducts to help the body digest fats.
Hepatic
Related to the liver.
Magnetic Resonance Cholangiopancreatography (MRCP)
MRCP uses magnetic resonance imaging, a noninvasive test that produces cross-section images of parts of the body.
Pancreatic Duct
Part of a system of ducts in the pancreas. Pancreatic juices containing enzymes are released into these ducts and flow into the small intestine.
Papilla
A small protruding portion of tissue.
Upper GI Endoscopy
Looking into the esophagus, stomach, and duodenum with an endoscope.

More about Endoscopic Retrograde Cholangiopancreatography

Photo of an adult man

Also called: Diagnostic endoscopic retrograde cholangiopancreatography, Diagnostic endoscopic retrograde examination of bile duct and pancreatic duct, Endoscopic catheterization of bile duct and pancreatic duct

See Also: Imaging Tests

Other terms to know: See all 11
Bile Ducts, Catheter, Common Bile Duct

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