Archive | January 2012

Endoscopic retrograde cholangiopancreatography (ERCP)

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.

Diagnostic

Fluoroscopic image of common bile ductstone seen at the time of ERCP. The stone is impacted in the distal common bile duct. A nasobiliary tube has been inserted.

Fluoroscopic image showing dilatation of the pancreatic duct during ERCP investigation. Endoscope is visible.

Therapeutic

  • Any of the above when the following may become necessary
    • Endoscopic sphincterotomy (both of the biliary and the pancreatic sphincters)
    • Removal of stones
    • Insertion of stent(s)
    • Dilation of strictures (e.g. primary sclerosing cholangitis, anastomotic strictures after liver transplantation)

Procedure

  • 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.

Coudé catheter

 

 

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.