ERCP Procedure - Indications, Treatment, Surgery and Cost
At Pace Hospitals, latest endoscopic suite is equipped with world-class endoscopic equipment to perform minimally invasive major and supra-major endoscopic procedures.
Our team of the best gastroenterologist in Hyderabad and gastroenterology specialist are having extensive experience in performing ERCP test.
What is ERCP and its purpose?
ERCP full form in medical - Endoscopic Retrograde Cholangiopancreatography
The purpose of ERCP procedure is to diagnose and treat abnormalities with the pancreas, bile ducts, gallbladder and liver. ERCP scope has a functionality of X-rays imaging called as fluoroscopy that is integrated within an endoscope, which is a long flexible tube having light on the front.
The scope is guided through the esophageal, stomach, and the first section of the small intestine by a gastroenterologist. The doctor can look inside these organs to see if there are any issues, then inject a dye through a thin, flexible tube called a catheter that's been pushed through the scope. On X-ray, this draws attention to the organs.
What are the uses of ERCP Procedure?
These are some situation when ERCP procedure is commonly suggested to the patients:
- Diagnosis - diagnosing the problems related to pancreas, common bile ducts, gallbladder and liver
- Stone Removal – to remove the gallstones that are struck in common bile duct not from gallbladder
- Stent Placement – to place a stent when a person has narrowed or blocked pancreatic or bile duct
- Biliary Endoscopic Sphincterotomy – to create small opening in common bile duct and pancreatic duct to help proper drainage of pancreatic, bile juices and small gall stones.
- Stent Removal – to remove previously placed stent to treat the conditions of pancreas, common bile duct, liver and gallbladder.
How does an ERCP procedure perform?
A person can have an ERCP procedure as part of a hospital stay. A person may experience and have to follow these steps while going for ERCP test:
- Any clothing, jewelers, or other items that could interfere with the process should be removed.
- You'll have to strip down to your clothes and change into a surgical gown.
- Your arm or hand will have an intravenous (IV) line inserted.
- During the procedure, you may receive oxygen via a tube in your nose.
- On the X-ray table, you will be either on your left side or, more commonly, on your stomach.
- A numbing drug sprayed into the back of your throat may be used. As the endoscope is passed down your throat, this prevents you from gagging. During the process, you will be unable to swallow the saliva that gathers in your mouth. As needed, it will be suctioned out of your mouth.
- To prevent you from biting down on the endoscope and to protect your teeth, a mouth guard will be placed in your mouth.
- Once your throat has been numbed, and you have become relaxed as a result of the sedative. The endoscope will be guided down the esophagus, through the stomach, and through the duodenum until it reaches the biliary tree channels.
- The biliary tree will be infused with contrast dye using a tiny tube inserted through the endoscope. Before the contrast dye, air may be introduced. You can feel full in your stomach as a result of this.
- There will be multiple X-ray views taken. During this period, you may be asked to move around.
- The tiny dye injection tube will be moved to the pancreatic duct once X-rays of the biliary tree have been taken. An X-ray will be taken after a contrast dye is injected into the pancreatic duct. While the X-rays are being taken, you may be asked to change positions again.
- Your doctor will obtain fluid or tissue samples if necessary. While the endoscope is in place, he or she may perform other treatments such as gallstone removal or other blockages.
- The endoscope will be withdrawn after the X-rays and other procedures are completed.
What are the Risk factors and Complications of ERCP?
You should inquire about the amount of radiation utilized during the test with your healthcare practitioner. Inquire about the hazards that are relevant to you.
Consider keeping a record of all X-rays you receive, including previous scans and X-rays for other purposes.
The amount of X-rays you have over time may influence your risk of radiation exposure. Kindly inform in advance
- If you're pregnant or suspect you might be. Radiation can cause birth abnormalities if it is consumed during pregnancy.
- If you have an allergy or sensitivity to drugs, contrast dyes, iodine, or latex.
The following are a few potential complications of ERCP:
- Pancreatitis
- Gallbladder inflammation (cholecystitis)
- Very small risk of having bleeding due to sphincterotomy performed. There are some early signs of possible complications of ERCP such as severe abdominal pain, chills, fever, vomiting and blood in stool, these need to be informed to avoid further problems.
However, in some cases of pancreatitis, ERCP is used to assist in relieving these symptoms:
- Infection
- Bleeding
- A tear in the upper intestine, oesophagus, or stomach lining.
- Outside the biliary system, bile is collected (biloma)
If you have any of the following conditions, you may not be eligible for ERCP:
- The biliary tree's ducts have been obstructed due to gastrointestinal (GI) operations.
- You have pouches (esophageal diverticula) or other aberrant anatomy in your oesophagus that makes the test difficult to execute. In certain cases, the ERCP may be adjusted.
- Because a recent barium operation may interfere with an ERCP, you have barium within your intestines.
- Other dangers may exist, depending on your state of health. Before the operation, make sure you talk to your doctor about any concerns you have.
How should I prepare for an ERCP?
The gastroenterologist or medical practitioner who will do your ERCP will discuss the procedure's risks and benefits with you. After that, you'll sign a consent form for the ERCP test, acknowledging that you've read and understood the procedure. Before surgery, you will be informed about what to do and what to avoid. These are some general rules that you have to follow before surgery:
- Before surgery, stop eating and drinking at the time advised by your doctor.
- You may take drugs that your doctor has recommended the morning of your surgery, only take these medicines with a sip of water.
- Certain medications may need to be stopped prior to surgery, advised by your surgeon.
- Inform about your allergies in advance to your surgeon.
After the treatment, you will need someone to drive you home. You may also require nightly assistance. Inquire with your doctor or nurse about how much assistance you may require.
What happens after ERCP?
You will be shifted to the recovery room after the treatment. You will be taken to your hospital room or discharged from the hospital once your blood pressure, pulse, and respiration have normalized, and you are aware. If you had this treatment as an outpatient, make arrangements for someone to take you home.
- You won't be able to eat or drink until your gag reflex has returned. For a few days, you can feel a painful throat and difficulty swallowing. This is quite normal.
- To reduce the risk of pancreatitis, an ERCP is frequently followed by a rectal suppository of a specific medication.
- Unless your healthcare professional instructs you differently, you can return to your normal diet and activities after the surgery.
If you have any of the following symptoms, let your doctor know:
- Chills or fever
- The IV site may be red, swollen, or bleed, as well as have additional discharge.
- Irritable bowel syndrome, nausea, or vomiting are all symptoms of Irritable Bowel Syndrome
- Stools that are dark, tarry, or red
- Sucking Issues
- Worsening throat or chest pain
Depending on your circumstances, your healthcare professional may provide you with additional instructions following the surgery.
Difference between an MRCP and a ERCP | MRCP vs ERCP
| MRCP | ERCP |
|---|---|
| Magnetic resonance cholangiopancreatography or MRCP, is a noninvasive MRI test to scan biliary system, with the help of contrast doctor can visualize liver duct, bile duct, pancreatic duct and complete ductal anatomy. | ERCP is a minimally-invasive therapeutic interventional endoscopic procedure provides high-resolution images with the help of side viewing endoscope. |
| MRCP is only diagnostic procedure. | ERCP is both diagnostic and therapeutic. |
| MRCP can’t treat the patient conditions. | ERCP can treat the patient conditions, by the help of side viewing scope the doctor can place stent, remove the stones, do the stricture dilatation and take biopsies. |
Frequently asked questions:
Does ERCP hurt or painful?
Patients may not feel pain during procedure because ERCP test performed under anesthesia. Post-ERCP some of the patients may have a little abdominal discomfort and pain that subsides within 24 to 48 hrs. Despite the fact that many individuals fear the endoscopy, the majority of people tolerate it well and recover quickly.
How long does it take to get results from ERCP?
Usually, ERCP test results are available after 30 mins to 45 mins after the completion of the procedure.
How long does an ERCP take?
ERCP procedure usually take 45 mins to 60 mins unless it is the redo procedure or complicated patient’s conditions further that may will take 90 mins to 120 mins (1 and 1/2 hours to 2 hours).
What are the indications of ERCP test?
ERCP test indicated to the patients with any of disease or condition such as obstruction to the bile duct (bile duct stone or bile duct stricture), hilar cholangiocarcinoma, distal cholangiocarcinoma, distal cbd stricture, distal cbd cholangiocarcinoma, distal cbd obstruction, distal cbd calculus etc. It can also be done in the patients with chronic pancreatitis and pancreatic cancer.
Is cholecystectomy necessary after ERCP?
Cholecystectomy is not necessary after ERCP, it is only required when patients are presented with Gallbladder stone or CBD stone.
What is the role of ERCP test in pancreatitis patients?
ERCP is helpful in pancreatitis patients in two ways, diagnosis wherein gastroenterologist can obtain pancreatogram and cholangiogram to look for bile duct or pancreatic duct abnormalities which can cause recurrent pancreatitis, pancreas divisum, pancreatic stone, pancreatic stricture, pancreatic ductal adenocarcinoma, pancreatic ductal dilatation and other is therapeutic wherein gastroenterologist can do stenting for pancreatic duct to drain the fluid that can relieve the symptoms.
How long does post ERCP pancreatitis last?
Post ERCP pancreatitis is a serious condition that can last upto one week (7 days) in severe condition and in mild condition it can settle down in 2 to 3 days.
Who performs ERCP?
A gastroenterologist performs ERCP with the help of a side viewing endoscope, with which the doctor can see the medial wall of duodenum and perform the procedure.
How long does it take to recover from ERCP?
Patient can recover within 6 hours from ERCP, it usually performed as day care procedure or maximum 24 hours of the stay in the hospital.
What is an ERCP procedure with stent?
ERCP procedure with stent is done for draining the bile duct or pancreatic duct juices into the intestine in case of narrow duct due to stricture.
Is pain common after ERCP with stent?
In an uncomplicated case there is no pain after ERCP with stent wherein if there are any complications or prior to the procedure the patient is already in cholangitis, there can be mild pain after the procedure.
Is ERCP safe?
ERCP is a safe procedure when performed by an expert gastroenterologist, and it also depends upon the setup, indications for the procedure and team of experts.
Can gallstones be removed by ERCP?
There are some cases where our team of experts have removed gallstones by ERCP by entering through the cystic duct with help of spy glass scope retrieving the stone or by lithotripsy. These cases are experimental and yet to get approval.
Can ERCP be done without anaesthesia?
ERCP is an invasive procure, and it is recommended to have the procedure under short general anesthesia, which is safer for patients and for better results.
Can ERCP cause chronic pancreatitis?
ERCP doesn’t cause chronic pancreatitis.
Can ERCP done as outpatient?
ERCP can be done as an outpatient day care procedure, and it also depends upon the patient’s conditions
Can MRCP be done after ERCP stenting?
MRCP can be done after ERCP stenting, but it is not ideal because stent may interfere in MRCP reports, nevertheless it depends upon case to case.
Can stent in ERCP removed during cholecystectomy?
Stent in ERCP cannot be removed during cholecystectomy because cholecystectomy done outside the lumen whereas ERCP done in the lumen.
Is ERCP lithotripsy performed by surgery or endoscopy?
ERCP lithotripsy is a kind of endoscopic surgery, it is done by the special scope called as spyglass scope that goes into the bile duct through that laser fiber comes with that ERCP lithotripsy is performed.
Does ERCP cause high amylase level?
ERCP can cause high amylase level, if ERCP is complicated and leads to acute pancreatitis.
Is there any food restriction immediately after ERCP?
In any procedure which is done under general anesthesia, there is always a protocol of 6 hours of NBM (nothing by mouth) after the procedure. Food restrictions are there only for a day, after that patients can have normal diet if the patient is not having acute pancreatitis.
What if ERCP doesn't work?
If ERCP doesn't work, then the gastroenterologist can perform an alternative procedure like endoscopic ultrasound guided stenting or endoscopic ultrasound intervention. Other way is following percutaneous approach called as PTBD (percutaneous transhepatic biliary drainage).
What are the side effects of ERCP test?
By and large there are no side effects of ERCP test except perforation, bleeding, infection and pancreatitis which are usually less than in 1 to 3% of the patients.
What is ERCP and eswl lithotripsy?
ERCP and eswl lithotripsy both are different procedures, in ERCP by going inside gastroenterologist can perform lithotripsy whereas external lithotripsy is by doing X-ray shooting on pancreatic stone or CBD stone and pulverize the stones by locating it through continuous X-ray and fluro, usually it is very cumbersome process and might take days to break the stone and relieve the symptoms.
What is balloon sweep ercp and balloon trawl ercp?
Balloon sweep ERCP is usually done to remove the bile duct and pancreatic duct stones, in this gastroenterologist go inside with the ERCP scope and through the guide wire place the CBD or biliary balloon swipe in from up to down to remove stones that are stuck up in the bile duct or pancreatic duct.
What is ERCP stent placement?
ERCP stent placement is the procedure which is done for relieving the obstructive jaundice in a patient who has a got difficulty in draining up the bile or pancreatic juices due to dilated or obstructed bile duct, pancreatic duct.
What all are the post ercp pancreatitis symptoms?
Post ERCP pancreatitis usually behave the same as any other pancreatitis with symptoms of severe abdominal pain radiating to back, vomiting, fever, distention of abdomen, sometimes it can be systemic involvement of respiratory system and other organs.
What is the cost of ERCP stent removal?
The average cost of ERCP stent removal in India is approximately 25,000 (Rupees twenty-five thousand only). However, ERCP stent removal cost in India, ranges vary from Rs. 18,000 to Rs. 28,000 (Rupees eighteen thousand to twenty-eight thousands) depends upon the different private hospitals in different cities.
ERCP stent removal cost in Hyderabad ranges vary from Rs. 15,000 to Rs. 25,000 (Rupees fifteen thousand to twenty-five thousands). However, cost of ERCP stent removal depends upon the multiple factors such as place of stent, procedure time, room selection and corporate or insurance for cashless facility.
What is the price / cost of ERCP in Hyderabad?
The average ERCP procedure cost in Hyderabad is approximately 42,000 (Rupees forty-two thousand only). However, ERCP cost in Hyderabad, ranges vary from Rs. 35,000 to Rs. 45,000 (Rupees thirty-five thousand to forty-five thousands). Cost of ERCP in Hyderabad depends upon the multiple factors such as selection of room for hospital stay and corporate, EHS, CGHS, ESI or cashless medical insurance facility.
What is the price / cost of ERCP test in India?
The average price of ERCP test in India is approximately 48,000 (Rupees forty eight thousand only). However, ERCP test price in India ranges vary from Rs. 35,000 to Rs. 55,000 (Rupees thirty five thousand to fifty-five thousands) and ERCP procedure cost may vary depending upon the different private hospitals in different cities.
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