The test called endoscopic retrograde cholangiopancreatography (ERCP) is a mixed endoscopic and radiological intervention, used to study and, mainly to treat, diseases of the bile ducts and pancreas. The duct that leads the bile to the intestine, from the gallbladder and liver (called the bile duct), and the main duct that carries the secretions of the pancreas (called the Wirsung duct), join in the same place to pour into the duodenum (first part of the small intestine) its substances, which are necessary for digestion.
We use this procedure to treat bile and pancreatic duct problems, and also to diagnose bile and pancreatic duct problems if they hope to treat the problems during the procedure. If it is a diagnosis only, doctors can use non-invasive tests, which do not physically enter the body, instead of ERCP. Non-invasive tests, such as magnetic resonance cholangiopancreatography, a type of magnetic resonance imaging, are safer and can also diagnose many problems of the biliary and pancreatic ducts.
We performed an endoscopic retrograde cholangiopancreatography when the bile or pancreatic ducts have narrowed or blocked due to:
- gallstones that form in the gallbladder and get trapped in the bile duct
- infections
- acute pancreatitis
- chronic pancreatitis
- trauma or surgical complications in the bile or pancreatic ducts
- pancreatic pseudocysts
- tumors or cancers of the bile ducts
- tumors or cancers of the pancreas
The procedures that are performed most frequently are:
- Papillotomy o Sphincterotomy: It is done with a cannula that has a sharp thread at its tip called papillotome. It consists of cutting the sphincter fibers located in the Vater ampulla, called the sphincter of Oddi. It is useful in most of the above-mentioned pathologies since it allows the introduction of other therapeutic instruments and also facilitates the removal of gallstones.
- Balloon sweep: It is useful for extracting stones from the bile duct. A cannula is inserted that has an inflatable ball at its tip. The ball passes while deflated and is placed distal to the stone, then it is inflated and with this the stone is pushed out.
- Sweep with basket: It is similar to the balloon sweep but it consists of a basket that opens in the bile duct and is manipulated until the calculus is placed inside. Once placed it closes to catch the stone and then it is extracted.
- Lithotripsy: Similarly, the stone is captured with the basket, only that pressure is exerted on the stone until it is disintegrated and then extracted. It is useful in larger stones that cannot be removed in one piece despite sphincterotomy.
- Dilatación: It is used in bile and pancreatic routes, both in benign (post-surgical, traumatic) and malignant strictures (cholangiocarcinoma, cancer of the head of the pancreas). Inflatable dilators or of increasing diameter are used. After dilation, a stent is usually placed in the narrow area that maintains the permeability of the pathway.
- Stent placement : The stent is a plastic or metal tube whose function is to allow drainage of the path where it is placed. It is used in tumors and in benign strictures. The plastics are temporary and are removed months or days later, the metallic ones are permanent and therefore, they are only used in neoplasms (tumor processes) proven for final therapeutic and selective purposes.