ERCP for Bile Ducts and Pancreas

Ever wondered how doctors diagnose and treat problems in the bile ducts and pancreas? At Pantai Hospital Ampang, we offer ERCP, a unique procedure that combines imaging and treatment for these delicate structures within the biliary tract. Dr Falah Akmal Zainal Ulum, Consultant General Surgeon with interest in hepatobiliary diseases sheds light on this procedure.

What is ERCP surgery?

ERCP stands for Endoscopic Retrograde Cholangiopancreatography. Here's a breakdown of this term:

• Endoscopic: Uses a thin, flexible tube with a camera (endoscope) to see inside your body.
• Retrograde: Inject contrast dye in a "backward" direction into your biliary ducts and main pancreatic duct.
• Cholangiopancreatography: X-ray images of these ducts filled with dye for a clearer view.

This type of gastrointestinal endoscopy is particularly useful for both diagnosis and therapy.

Who needs ERCP procedure?

Our specialist may recommend ERCP if you experience symptoms like unexplained upper abdominal pain or signs of blocked bile flow (jaundice). After taking history of your symptoms and thorough examination, a non-invasive diagnostic imaging procedure such as ultrasound, CT scan or magnetic resonance imaging (MRI) will be done to diagnose your problem and ERCP will be used to treat various biliary and pancreatic conditions, including:

• Inflammation or infection of the bile ducts (cholangitis)
• Narrowing bile duct by scar tissue (biliary stricture)
• Gallstones lodged in the common bile duct
• Pancreatitis caused by gallstones
• Tumors or cancer in the bile ducts
• Bile duct leaks or injuries

How does ERCP work?

ERCP combines two technologies:

• Endoscopy: Allows our doctors to see the opening of the bile and pancreatic ducts in your small intestine using a scope through your mouth. So, there will be no surgical scar!
• Fluoroscopy: Uses a special X-ray machine that takes real-time moving pictures as the contrast dye flows through your ducts.

During the exam, doctors are able to visualise structures like the major duodenal papilla, which is where the bile and pancreatic ducts empty into the small intestine.

Procedure and Steps

During the procedure:

1. You'll receive anaesthesia to keep you comfortable and relaxed.
2. The doctor inserts the endoscope through your mouth and guides it down your digestive tract.
3. A thin tube is passed through the endoscope to inject contrast dye into the bile and pancreatic ducts.
4. Fluoroscopy captures images as the dye travels, revealing any blockages, swelling, or leaks. Rest assured; the radiation emitted from the short bursts of X-ray beams are of a safe amount.
5. If needed, the doctor can use tiny instruments passed through the endoscope to:
• Break up and remove gallstones
• Collect tissue samples for biopsy
• Widen narrowed ducts
• Place stents to keep ducts open
• Repair leaks or injuries
• Open the muscle surrounding the duct opening

ERCP can be an essential procedure for both diagnosing and treating conditions such as acute pancreatitis and chronic pancreatitis, especially if these are related to gallstones or structural issues of the ducts.

What to expect after ERCP?

1. You'll rest at the hospital for a while before going home.
2. You may experience a sore throat, bloating, nausea, or mild discomfort for a day or two.
3. Most people tolerate ERCP well, and the benefits outweigh the risks.

Things to know about ERCP at Pantai Hospital Ampang

• It's an outpatient procedure, meaning you go home the same day.
• It's not major surgery; it uses a natural opening (your mouth).
• While minimally invasive, there are potential risks like reactions to anaesthesia or dye, injury to the ducts, or infection.
• ERCP can be used to treat pancreatitis, especially when caused by gallstones or narrowed ducts.

The procedure allows direct intervention within the biliary system and biliary tree, offering targeted and efficient management of complex conditions.

What if you are pregnant?

If you are pregnant or think you might be, it's important to tell your doctor before scheduling an ERCP. While the amount of radiation used during fluoroscopy in ERCP is generally considered low, any radiation exposure during pregnancy should be avoided if possible.

Your doctor will discuss the potential risks and benefits of ERCP with you in detail and may explore alternative diagnostic options that don't involve radiation. However, if ERCP is deemed necessary, they will take steps to minimise radiation exposure to the fetus.

ERCP vs. Gastroscopy

ERCP is a more advanced endoscopic procedure. A regular gastroscopy only examines your upper digestive tract. ERCP uses a special attachment to reach and visualise the bile and pancreatic duct, allowing for treatment if needed.

Reach out to Pantai Hospital Ampang

ERCP is a valuable tool for treating bile duct and pancreatic issues. It may seem complex, but it offers a minimally invasive approach compared to traditional surgery. Talk to us at Pantai Hospital Ampang if you have any questions about ERCP or experience symptoms that may warrant this procedure.