Currently, diseases of the pancreas and liver are being diagnosed more and more often. It is most common in men between 25 and 45 years of age. These pathologies can be complicated by untimely access to a doctor. This is due to the fact that in the early stages of its development, the disease often does not have severe symptoms. In this regard, when certain signs appear, it is recommended to undergo an examination, which includes a number of methods. One of them is endoscopic retrograde cholangiopancreatography. What is it and how this procedure is carried out, we will consider in the article.
Definition
Endoscopic retrograde cholangiopancreatography (ERCP) - what is it? This procedure is a combined examination, including both endoscopic and x-ray examination of the pancreas andbile ducts. ERCP is currently considered one of the most accurate diagnostic measures. The examination is carried out in a hospital, in a specially equipped X-ray room.
But it is worth remembering that this method, according to experts, is considered very traumatic and can lead to serious complications. In this regard, endoscopic retrograde cholangiopancreatography is not performed for prophylactic purposes.
Indications for the procedure
ERCP is a technically demanding test with a potential for complications. In this regard, the doctor decides to prescribe this procedure only in certain cases, for example, if serious diseases are suspected that are associated with obstruction of the bile ducts and pancreatic ducts.
Indications for endoscopic retrograde cholangiopancreatography are the following pathological conditions:
- Chronic pancreatitis.
- Mechanical jaundice. The reason for this can be any mechanical damage to the bile ducts (tumor, compression).
- Suspicions of tumor processes of the bile ducts and gallbladder.
- Pancreatic fistulas.
- Suspicion of stones in the ducts.
- Enlargement of the pancreas and heterogeneity of its structure.
- Inflammation of the bile ducts.
- Suspicion of pancreatic cancer.
- Suspicion of a fistulabile ducts. A fistula is a pathological opening in the wall of an organ, which may occur due to trauma or an untreated inflammatory process. Bile in this case has the ability to be released through the fistula into the surrounding tissues and organs, causing dangerous complications.
Medical indications
In some cases, endoscopic retrograde cholangiopancreatography can also be used for medical purposes:
- To remove stones from the biliary tract.
- For bile duct stenting.
- To perform a sphincterotomy (creating a small incision in the common bile duct, necessary for the outflow of bile and the release of small stones).
- For papillosphincterotomy. This procedure is carried out if the stones in the biliary tract are large enough and cannot independently pass into the intestine through the duodenal papilla. During cholangiopancreatography, an incision is made in one of the walls of the duodenal papilla, which allows the stones to be removed without problems.
Contraindications to the procedure
Since ERCP is one of the tests that can cause dangerous complications, there are a number of contraindications to this procedure. These include the following states:
- acute pancreatitis;
- acute viral hepatitis;
- pregnancy;
- acute cholagnitis;
- stenosis of the duodenum and esophagus;
- insulin therapy;
- pancreas neoplasmsgland;
- stenosing duodenal papillitis;
- taking antithrombotic drugs;
- diseases of the cardiovascular system;
- allergic to radiopaque.
Pre-procedure tests
Due to the fact that endoscopic retrograde cholangiopancreatography is a complex and rather responsible examination, careful preparation is necessary to minimize complications and discomfort. It is performed in a hospital setting and includes the following:
- Clinical analysis of urine and blood.
- Biochemical blood test.
- Fluorography.
- Ultrasound examination of the abdominal cavity.
- Electrocardiogram.
- Sometimes an MRI may be required.
Preparatory actions
The patient must also observe the following rules:
- Do not eat or drink water on the day of the examination. The last meal should be no later than 19 hours of the previous day.
- Do not smoke during the day before the procedure, as during smoking a considerable amount of mucus is formed in the airways, which can provoke a spasm.
- Do not drink alcohol 4-5 days before the examination.
- The night before the ERCP, a cleansing enema should be given.
- The patient must notify the doctor about the use of drugs, after which their temporary cancellation or dosage adjustment will be required.
Medications that are used during the periodpreparation for endoscopic retrograde cholangiopancreatography, these are drugs from the following list:
- "Atropine";
- "Dimedrol";
- "Metacin";
- "Promedol";
- "No-Shpa";
- "Buscopan";
- Sedative drugs that are recommended to be taken a few days before the examination (for example, Novo-Passit).
The above funds are administered intramuscularly. They help to reduce salivation, reduce the contractility of the muscles of the gastrointestinal tract and pain.
It is important to remember that all medications should be used only after a doctor's prescription. Self-medication can aggravate the situation.
Procedure technique
Many are interested in the question of how endoscopic retrograde cholangiopancreatography is performed. Consider the survey method in more detail:
- After completing the preparatory measures, the patient is placed on the left side.
- In most cases, local anesthesia is used with "Lidocaine" - they are lubricated with a throat to reduce pain and discomfort during the introduction of the endoscope. Many people think that endoscopic retrograde cholangiopancreatography is a procedure that is performed under general anesthesia, but this is actually not the case. Deep anesthesia is used only in cases where verypainful and difficult manipulations.
- A mouthpiece is inserted into the mouth.
- The patient is asked to take a deep breath and an endoscope is inserted through the mouth leading to the stomach and then to the duodenum. Advancing the device, the specialist examines the mucosa.
- Having reached the duodenum, the doctor launches air into its cavity, which inflates the walls of the organ for more accessible research.
- Finding the duodenal papilla, the doctor inserts a special catheter into it, through which a contrast agent is injected into the pancreatic and biliary tract.
- After all the ducts are filled with substance, x-rays are taken, which are displayed on the monitor, and sometimes printed out.
- If it is necessary to carry out medical manipulations to determine the tumor, an instrument is inserted through the endoscope to take material for a biopsy. Also, during the examination, it is possible to perform a procedure to eliminate pathologies of the duodenal papilla.
- The doctor must examine the walls of the organ under study for active bleeding.
- Prevention of possible complications is being carried out.
- After all the manipulations, the endoscope is removed, and the patient is transferred to the ward, where specialists observe for some time.
Endoscopic retrograde cholangiopancreatography is a procedure that takes about an hour on average.
Post-operative recommendations
It should be noted that after the examination, according to patients, pain in the throat is observed for several days. Helplollipops for sore throats will be able to eliminate them.
Some time after the procedure, you must follow a diet number 5, which excludes fried, s alty, smoked foods. The use of alcohol is prohibited. Food should be mushy and at a comfortable temperature. The duration of the diet will be determined by the attending physician.
Possible Complications
Sometimes complications may occur during or after the examination. This is because endoscopic retrograde cholangiopancreatography is an invasive procedure. The most common dangerous consequences are:
- Pancreatitis. This is the most common complication, which is characterized by an increase in pain in the abdomen and an increase in the level of amylase in the blood. In this case, it is necessary to stay in the hospital for several days until the consequences are eliminated.
- Damage to the walls of the biliary tract or intestines. This can happen due to the carelessness of the doctor during the procedure or if the wall is damaged by a stone that the doctor is trying to remove. With a severe defect, bile can accumulate in the surrounding tissues, which will cause even more serious complications. In this case, suturing of the damaged area is required.
- Allergic reactions to injected contrast agent or anesthetic. The patient feels a headache, lack of air, dizziness, swelling of the mucous membranes and more.
- Cholangitis. Inflammatory lesion of the bile ducts. May occur due to damage to the mucosa during the procedure, as well as duringinfection during examination.
- Purulent complications.
- Bleeding.
In addition to the above complications, other unpleasant consequences may occur during endoscopic retrograde cholangiopancreatography - a sensation of a lump in the throat, heaviness in the stomach, flatulence, scratches in the pharynx, conjunctivitis and others.
If you experience a persistent fever, vomiting blood, paroxysmal pain in the abdomen, as well as throat bleeding, you should immediately consult a doctor. Delay in this case could cost a person their life.
Patient testimonials
Patients are interested in information about endoscopic retrograde cholangiopancreatography when they schedule an examination. What is it and what consequences should be expected, every patient should know. Many, having learned about the principle of the procedure, are frightened and try to refuse this examination. But ERCP is a very important study in some diseases, it cannot be neglected.
The opinions of patients after the procedure are quite contradictory, but in the vast majority of cases, reviews of endoscopic retrograde cholangiopancreatography (ERCP) confirm its undoubted benefits.
Conclusion
ERCP is an informative examination, but it can lead to complications. Therefore, it is very important to follow all the doctor's recommendations to reduce the risk of their occurrence. Subject to preparatory measures, the procedure will not lead to the development of dangerousconsequences.
