a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on X-rays.
ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP can be performed for diagnostic and therapeutic reasons.
- Obstructive jaundice – This may be due to several causes
- Chronic pancreatitis – a now controversial indication due to widespread availability of safer diagnostic modalities including endoscopic ultrasound, high-resolution CT, and MRI/MRCP
- Gallstones with dilated bile ducts on ultrasonography
- Bile duct tumors
- Suspected injury to bile ducts either as a result of trauma or iatrogenic
- Sphincter of Oddi dysfunction
- Pancreatic tumors no longer represent a valid diagnostic indication for ERCP unless they cause bile duct obstruction and jaundice. Endoscopic ultrasound represents a safer and more accurate diagnostic alternative
- Any of the above when the following may become necessary
- The patient is sedated or anaesthetized. Then a flexible camera (endoscope) is inserted through the mouth, down the esophagus, into the stomach, through the pylorus into the duodenum where the ampulla of Vater (the opening of the common bile duct and pancreatic duct) exists. The sphincter of Oddi is a muscular valve that controls the opening of the ampulla. The region can be directly visualized with the endoscopic camera while various procedures are performed.
Like the standard straight Foley catheter, the Coudé catheter is retained by means of a balloon at the tip which is inflated with saline. The balloons typically come in two different sizes: 5 cc and 30 cc. A Coudé catheter is designed with a curved tip that makes it easier to pass through the curvature of the prostatic urethra.