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Endoscopic retrograde cholangiopancreatography is a technique that is used when necessary to confirm diseases of the bile ducts and pancreas. Briefly, the technique is shortened to the abbreviation ERCP.
Diagnosis is based on the involvement of x-ray and endoscopic instruments. Their joint work guarantees the possibility of identifying current deviations in the work of these organs as accurately as possible. The method was first used back in 1968. Since then, technicians have significantly improved it in order to obtain detailed information about possible pathologies, not only acquired, but also congenital.
Based on the information received, the doctor can not only confirm his guesses on the diagnosis, but also use the collected data as the basis for the subsequent surgical intervention. It is not for nothing that such an examination is often included in the programs of mandatory preparatory measures before setting the date of the operation.
Step-by-step diagnostics
Despite the widespread use of this type of cholangiopancreatography, not all ordinary people understand what it is, at least in general terms. The procedure involves the use of a special device – an endoscope. It is injected into the duodenum, then attached to the mouth of the large duodenal papilla.
A probe is pulled through the channel of the endoscope along with a cannula to transfer the contrast solution. After the substance enters the body, the expert fixes the resulting visualization using X-ray equipment tuned to the desired mode. Based on the images obtained, a conclusion is made about the localization of the focus of the pathology, and it is also determined how much neighboring tissues and organs are involved.
Schematically, the method is divided into several stages, allowing in the shortest possible time with minimal discomfort for the patient to control a number of organs of the digestive tract. Manipulation begins with monitoring of the duodenum and duodenal papilla.
This is followed by cannulation of the papilla along with the introduction of a contrast solution for subsequent x-rays. Only after this is the filling of the ducts of the systems under study performed. At this stage, the shooting takes place directly.
The final step involves the extraction of a contrast agent from the duct, and then the prevention of possible side effects.
The price of the procedure will vary depending on the characteristics of the contrast agent, as well as the quality of the medical equipment used. Doctors are advised to contact clinics where there is the latest generation of equipment. It implies devices with lateral placement of optics, which is the key to an accurate and productive examination of internal organs. Contributes to the collection of information convenient angle.
Modern probes that are passed through the endoscope have a special cannula, which is made of high-density material. It easily rotates in the direction the laboratory assistant needs to fill the ducts with radiopaque solution as efficiently as possible. For convenience, the examination is almost always carried out in the office of conventional radiography in a hospital setting.
Preparatory Measures
To get the most reliable result, the preparation for ERCP should take place accordingly. Before starting the examination, the patient is sometimes given an injection with a sedative drug if he is very worried.
The procedure itself is technically quite complex in terms of execution, which entails pain during its implementation. Because of this, some experts insist that the patient be given a sedative injection even the day before the appointment.
Also, care should be taken to ensure that the study was carried out only on an empty stomach. Because of this, in most cases, this study is prescribed exclusively in the first half of the day. In addition to the ban on eating before the start of the inspection, there is an identical restriction on drinking.
Approximately half an hour before the scheduled time of the examination, the patient is injected intramuscularly with certain drugs. They are designed to work as relaxing agents that will have a beneficial effect on the condition of the duodenum. Without such a preliminary stage, it is unlikely that it will be possible to carry out the manipulation without hindrance.
But before introducing substances unfamiliar to the human body, you will need to conduct a control allergy test for a possible reaction. Only a scrupulous approach to the implementation of all preparatory instructions will allow leveling the risks of anaphylactic shock with possible individual intolerance to drugs.
Sometimes it happens that standard pharmacological agents do not work properly, and intestinal motility is preserved in its original form. Then you will have to postpone the date of the manipulation, using the next time medications aimed at suppressing the motor function of the intestine.
Basic indications
All thematic medical sources provide identical reasons for performing cholangiopancreatography, despite the fact that this is an invasive format for studying the health of certain organs. Due to the complexity of execution and pain, this examination is prescribed only according to medical recommendations, but not as a preventive measure.
The underlying symptoms that contribute to the issuance of a referral for such an analysis include:
- pain syndrome in the abdomen;
- violation of the patency of the bile ducts;
- stones in the ducts;
- neoplasms of a malignant or benign nature.
All of the above should be confirmed either by the corresponding complaints of the patient, or by the results of other laboratory, clinical studies.
Against the background of the above, the indications for invasive diagnostics are as follows:
- mechanical jaundice;
- swelling;
- chronic course of pancreatitis with a regular transition to the stage of exacerbation;
- pancreatic fistulas;
- preparation before surgery.
One of the most common causes of problems is the formation of choledochal stricture, which involves narrowing of the duodenal papilla, or choledocholithiasis. The latter option is characteristic of situations where cholelithiasis develops rapidly and has a whole bunch of complications of varying severity. In some people, stones completely get stuck in the bile ducts, which provokes a complete or partial blockage of the outflow of bile.
A similar anomaly is manifested by painful sensations in the region of the right hypochondrium. Sometimes the pain gives even in:
- right hand;
- lumbar area;
- subscapular and scapular regions.
If contrast-enhanced computed tomography or ultrasound diagnostics could not provide detailed visualization for suspected neoplasms, then ERCP is indispensable. The method is used as a final test.
Absolute contraindications
Due to the fact that the technique belongs to the category of invasive, by default it has a larger list of possible contraindications than non-invasive ones. Some of them are absolute. In this situation, experts recommend using other techniques for a thorough examination, which will be safer. Among them – ultrasound, for example, or MRI diagnostics, including with contrast.
The most important absolute contraindication of the general type is called the state of the body when a person cannot perform endoscopic intervention.
This may be a serious condition of the patient due to polytrauma, or permanent injuries.
This also includes mental disorders that encourage a person to perform uncontrollable actions. Such a deviation almost always guarantees significant damage to the organs of the digestive tract.
For the same reason, people with uncontrolled convulsive syndrome, which is characteristic of epileptic seizures, are not allowed to be examined. All of the above refers to absolute prohibitions for such an examination, as well as intolerance to certain drugs. They are used at the preparation stage and are sometimes replaced with similar ones, but since the active substance still remains the same, this does not solve the root of the problem. Hence the logical rejection of the study.
Separately, situations are considered when the patient has already been diagnosed with:
- acute pancreatitis;
- chronic pancreatitis.
The risks of accidentally damaging still healthy tissues are too high to go for such dangerous diagnostic measures.
Another group of contraindications are relative prohibitions. They provide for the possibility of ignoring them if the benefits of the analysis outweigh the possible harm. Each individual case is considered individually by the attending physician, since the percentage of complications is still high.
Relative contraindications include the following conditions:
- pregnancy and the period of breastfeeding;
- diseases of the cardiovascular system;
- insulin-dependent diabetes mellitus;
- the use of anticoagulants.
The last two are fairly easy to correct. The doctor will simply correct the therapy, thereby making the use of diagnostics safe. In exceptional cases, anticoagulants are even canceled for several days for the sake of the purity of the experiment. But it is strictly forbidden to take risks in this way without prior consultation with your doctor.
Serious and minor complications
According to medical standards, endoscopic retrograde cholangiopancreatography is a non-dangerous type of medical examination, if the algorithm for its appointment is strictly followed. But even it carries some side effects.
You will have to prepare for the fact that after the completion of the manipulation, the patient may encounter an infection. The attending physician will help to cope with its manifestations by prescribing appropriate medications to stop the problem.
No less often, patients experience intestinal perforation and bleeding. All this is not always the fault of the diagnostician, but the choice of an experienced specialist significantly reduces the likelihood of falling into the sad statistics of people with complications.
Another important point to avoid side effects is the correct behavior immediately after the examination. Do not break the rules by going home immediately after ERCP, even if everything seems to be fine. The next two to three hours should be spent under the strict supervision of medical personnel in a hospital inpatient department.
Often patients complain of discomfort in the throat after the insertion of the probe. To reduce negative manifestations, it is recommended to purchase several soothing throat lozenges in a pharmacy in advance.
You should also carefully monitor the change in well-being in the next 24 hours. At the slightest deterioration, you must immediately let the doctor on duty know. Especially dangerous manifestations are chills that appear along with a cough. No less threatening signs of deviations are nausea followed by vomiting, as well as severe pain in the sternum and abdomen.
The above almost always indicates that during the diagnosis, the doctor allowed damage to adjacent tissues. Their healing will require a long and proper rehabilitation under the supervision of the medical staff.