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Endoscopic Retrograde Cholangiopancreatography (ERCP )

Endoscopic Retrograde Cholangiopancreatography (ERCP )

ERCP is an endoscopic method used in the treatment of obstructions occurring in the biliary tract. The biliary tract can be blocked by biliary Stones falling from the gallbladder, or by the stone formed in the biliary tract de novo. The biliary tract opens into the small intestine, passing through the head of the pancreas. Tumors belonging to the biliary tract itself or of the pancreas can also cause obstruction to prevent bile flow. Stone-related obstructions generally occur acutely. It may present symptoms such as abdominal pain, suddenly developing jaundice, fever, chills while obstruction due to tumors develops jaundice gradually, presents generally painless jaundice.

ERCP technique:

Side vision endoscopy device (Duodenoscope) is used. Because the papilla region, which is the exit of the biliary tract to be treated, is located on the medial side of the second part of the duodenum (duodenum). The endoscopy device is designed to see the sidewall, not the front, in order to operate in a way to see it from across view.

When the duodenoscope confronts the biliary tract, a plastic catheter called a papillotomy is pushed into the biliary tract through the papilla. Liquid contrast material is injected through the catheter into the biliary tree. The liquid contrast material given under fluoroscopy guidance makes the route visible as the black and white silhouette. If there are stones or tumors inside, these will be manifested as a lack of paint in the silhouette as they will create a filling defect.

ERCP is performed to alleviate the obstruction of the biliary tract. when there occurs a complete obstruction of the biliary tree, in that case, you will see yellowish discoloration of conjunctiva and skin meanwhile patients might lose the normal color of stool. it appears clay-colored fatty tissue. if the obstruction takes a longer time, in that case, the obstructive biliary tree might get infected so that patients will experience fever and chills. this situation is an emergency case.  the biliary tract obstruction should be relieved by any means.

ERCP is one of the mostly used and efficient ways of relieving biliary obstruction.  it is an endoscopic procedure performed under sedoanalgesia in the endoscopy unit. The endoscopic instrument which is called duodenoscope is passed through the esophagus till the second portion of the duodenum where you will see the outlet of the main biliary channel.

After the stone is detected, the mouth of the biliary tract is enlarged up to 8 to 10 mm in diameter with electrocautery using a papillotomy device. After the biliary tract opening has been dilated, the Stone is removed with a basket or Balloon, which is passed through the channels of the endoscopy device. The obstructing tumor is sampled with cytology brushes and / or biopsy forceps. In order to ensure bile flow, a temporary plastic biliary stent is usually placed in the biliary tract to provide drainage. It is very important to provide this drainage in order to remove jaundice and prevent the blocked bile ducts from inflammation (cholangitis).

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