Norm of Endoscopic Retrograde Cholangiopancreatography (ERCP)
Patent bile ducts, duodenal papilla, pancreatic ducts, and gallbladder.
Usage of Endoscopic Retrograde Cholangiopancreatography (ERCP)
Determine the cause of cirrhosis, evaluate jaundice, obtain tissue samples from the pancreatobiliary tree, and diagnose cholangitis, pancreatic cancer, pancreatitis, pancreatic cysts, pancreatic ductal lesions, pancreas divisum, and papillary stenosis. After the ERCP, by endoscopy, cysts can be drained, stones can be removed from the common bile duct, and stents can be placed across biliary or pancreatic strictures.
Description of Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography (ERCP) is the radiographic viewing of the hepatobiliary tree and pancreatic ducts through an endoscope using contrast medium injected through the ampulla of Vater. ERCP is used for detection of common bile duct stones when the probability for this condition is high. A newer test—endoscopic ultrasound (EUS)—is also used for detection of stones in the common bile duct. EUS is less risky because it does not involve exposure to radiation. See Endoscopic ultrasound.
Professional Considerations of Endoscopic Retrograde Cholangiopancreatography (ERCP)
Consent form IS required.
Cholangitis, dysrhythmias, hemorrhage, pancreatitis, perforation of intestine, peritonitis, sphincter of Oddi dysfunction.
Anticoagulant therapy, bleeding disorders, thrombocytopenia, renal insufficiency. Sedatives are contraindicated in clients with central nervous system depression.
During pregnancy, risks of cumulative radiation exposure to the fetus from this and other previous or future imaging studies must be weighed against the benefits of the procedure. Although formal limits for client exposure are relative to this risk/benefit comparison, the United States Nuclear Regulatory Commission requires that the cumulative dose equivalent to an embryo/fetus from occupational exposure not exceed 0.5 rem (5 mSv). Radiation dosage to the fetus is proportional to the distance of the anatomy studied from the abdomen and decreases as pregnancy progresses. For pregnant clients, consult the radiologist/radiology department to obtain estimated fetal radiation exposure from this procedure.
- A kidney-ureter-bladder (KUB) flat-plate radiograph of the abdomen is taken to determine the absence of barium.
- See Client and Family Teaching.
- Obtain a topical anesthetic, sedative, and endoscope.
- Establish intravenous access.
- Antibiotic prophylaxis before ERCP results in fewer cases of cholangitis in clients with obstructive jaundice et al, 2002.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- A topical anesthetic is applied to the oropharyngeal area.
- Sedatives are given intravenously.
- The client is placed in the left lateral position.
- The endoscope is inserted through the esophagus to the stomach and then into the duodenum.
- The client is then placed in the prone position, the papilla is cannulated with a catheter, and contrast dye is injected into the pancreatic or bile ductal system.
- Several radiographs are taken, and then biopsy specimens may be taken if desired.
- The client should have nothing by mouth until the gag reflex returns.
- If deep sedation was used, follow institutional protocol for post sedation monitoring. Typical monitoring includes continuous ECG monitoring and pulse oximetry, with continual assessments (every 5–15 minutes) of airway, vital signs, and neurologic status until the client is lying quietly awake, is breathing independently, and responds appropriately to commands spoken in a normal tone.
- Assess for the complications of urinary retention and intra-abdominal hematoma.
- Transient rise in serum liver enzymes is common up to 24 hours after ERCP.
Client and Family Teaching
- Fast from food and fluids for 12 hours before and after the procedure until the gag reflex returns.
- The procedure takes approximately 1 hour.
Factors That Affect Results
- Retained barium can obstruct viewing.
- Up to 95% of the pancreatic duct and 85% of the biliary duct can be visualized by an experienced physician.
- Useful in differentiating surgical from medical jaundice.
- Therapeutic ERCP has a significantly higher complication rate (4.6%) and higher death rate (0.5%) when compared to diagnostic ERCP.
- Magnetic resonance cholangiopancreatography (MRCP) may make diagnostic ERCP obsolete and is more effective in the evaluation of intrahepatic stones. ERCP is not well-suited for intrahepatic stones because of the frequency of biliary strictures and the angulation of the ducts. ERCP is, however, more sensitive in detecting common bile duct stones than is computed tomography cholangiography.
- For detection of pancreatobiliary malignant obstruction, MRCP, ERCP, and EUS provide similar diagnostic results.
- Factors that may indicate the presence of gallstones include clinical jaundice or elevated bilirubin, liver function tests, and common bile duct dilation (identified via ultrasound).