JAMA PATIENT PAGE Endoscopic Retrograde Cholangiopancreatography Endoscopic retrograde cholangiopancreatography (ERCP) is performed by gastroenterologists or surgeons to evaluate the bile duct, pancreatic duct, and ampulla. Bile and pancreatic enzymes are released into the small bowel to assist digestion. Bile flows from the liver, is stored in the gallbladder, then flows through the common bile duct. Similarly, pancreatic enzymes flow from the pancreas through the pancreatic duct. The ampulla is the confluence of the biliary and pancreatic ducts. Both of these ducts can become blocked or narrowed by stones, tumors, or inflammation. Endoscopic Retrograde Cholangiopancreatography (ERCP) ERCP is a procedure used to investigate abnormalities of the bile duct, pancreatic duct, and ampulla using an endoscope. Common bile duct Endoscope Stomach LIVER How ERCP Is Used DUODENUM Duodenum e Pancreas Flo wo f bil The ERCP procedure is used to investigate abnormalities of the common bile duct, pancreatic ducts, and ampulla. It can also be used to perform certain therapeutic interventions. The procedure is performed with a specialized endoscope, a long, maneuverable tube with a camera that passes through the mouth, esophagus, and stomach to work within the duodenum. A miniaturized video camera on the tip of the endoscope allows the doctor to see a greatly magnified view of the inside of the gastrointestinal tract on a video monitor. Images of the bile and pancreatic ducts are made by injecting a special liquid (a radiocontrast agent) into the ducts while taking x-rays. Specialized instruments are passed through the endoscope to perform biopsies, retrievestones,dilateanarrowing,orplacea stent (ashorthollowtube that allows bile or pancreatic fluid to flow past a narrowing). Endoscope features Camera allows physician to see inside duodenum, ampulla, and ends of ducts Probe/instruments perform biopsies, clear stones, dilate a narrowing, or place a stent Pa nc re Ampulla a ti Pancreatic duct c enzy m e s Endoscopic view Side Effects Probe Most patients tolerate ERCP without significant complications. Minor complications are associated with anesthesia and occur in 5% to 7% of patients. More significant risks include pancreatitis (inflammation of the pancreas) in 3% to 5% of patients (as high as 15% in high-risk patients), bleeding, infection, and, rarely, perforation of the intestines. What to Expect Prior to ERCP, you may be asked to abstain from eating and drinking for at least 6 hours. The procedure is performed using either deep sedation (a form of anesthesia in which a patient is allowed to breathe on his or her own) or general anesthesia (with a breathing tube) depending on the patient and the complexity of the procedure required. Patients undergoing the procedure are typically comfortable without significant pain during or afterward and generally do not remember the procedure at all. Often, ERCP is performed in an outpatient setting. Authors: Ioana Baiu, MD, MPH; Brendan Visser, MD Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. No disclosures were reported. Sources: NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. NIH Consens State Sci Statements. 2002;19(1):1-26. Wandling MW, Hungness ES, Pavey ES, et al. Nationwide assessment of trends in choledocholithiasis management in the United States from 1998 to 2013. JAMA Surg. 2016;151(12):1125-1130. 2050 Patients are placed under deep sedation or general anesthesia during the procedure. FOR MORE INFORMATION • American College of Gastroenterology patients.gi.org/topics/ercp-a-patients-guide The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776. JAMA November 20, 2018 Volume 320, Number 19 (Reprinted) © 2018 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 05/15/2020 jama.com
