Currently, diseases of the pancreas and liver are increasingly being diagnosed. This is most common in men from 25 to 45 years old. These pathologies can be complicated by untimely access to a doctor. This is due to the fact that at the first stages of its development, the disease often does not have pronounced 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 this 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 and biliary tract. ERCP today is 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 complex examination with the likelihood of complications. In this regard, the doctor decides on the appointment of this procedure only in certain cases, for example, if serious diseases are suspected that are associated with obstruction of the bile duct and pancreatic ducts.
The following pathological conditions are indications for endoscopic retrograde cholangiopancreatography:
- Chronic pancreatitis.
- Obstructive jaundice. The reason for this may be any mechanical damage to the biliary tract (tumor, compression).
- Suspicion of tumor processes of the bile duct and gall bladder.
- Pancreatic fistula.
- Suspicion of the appearance of stones in the ducts.
- The increase in the pancreas and the heterogeneity of its structure.
- Inflammation of the bile ducts.
- Suspected pancreatic cancer.
- Suspected bile duct fistula. A fistula is a hole of a pathological nature in the wall of an organ that can occur due to trauma or an untreated inflammatory process. In this case, bile has the ability to be secreted through the fistula into surrounding tissues and organs, causing dangerous complications.
Medical indications
In some cases, endoscopic retrograde cholangiopancreatography can also be used for medicinal purposes:
- To remove stones from the biliary tract.
- For stenting the bile duct.
- For sphincterotomy (creating a small incision in the common bile duct, necessary for the outflow of bile and the exit of small stones).
- For papillosphincterotomy. This procedure is carried out if the stones in the biliary tract are large enough and cannot independently enter the intestine through the duodenal papilla. During cholangiopancreatography, an incision is made on one of the walls of the duodenal papilla, which allows the stones to move away without problems.
Contraindications to the procedure
Since ERCP refers to examinations in which dangerous complications may arise, there are a number of contraindications to this procedure. These include the following conditions:
- acute pancreatitis;
- acute viral hepatitis;
- pregnancy;
- acute cold
- stenosis of the duodenum and esophagus;
- insulin therapy;
- pancreatic neoplasms;
- stenotic duodenal papillitis;
- taking antithrombotic drugs;
- diseases of the cardiovascular system;
- allergy to radiopaque substance.
Analyzes before the procedure
Due to the fact that endoscopic retrograde cholangiopancreatography is a complex and rather responsible examination, thorough preparation is necessary to minimize complications and uncomfortable conditions. It is performed in a hospital and includes the following:
- Clinical analysis of urine and blood.
- Biochemical blood test.
- Fluorography.
- Ultrasound examination of the abdominal cavity.
- Electrocardiogram.
- MRI may sometimes be required.
Preparatory Activities
The patient must also observe the following rules:
- On the day of the examination, do not eat or drink water. The last meal should be no later than 19 hours on the previous day.
- Do not smoke during the day before the procedure, since during smoking in the respiratory tract a considerable amount of mucus is formed, which can provoke a spasm.
- Do not drink alcohol 4-5 days before the test.
- On the eve of ERCP, a cleansing enema is necessary.
- The patient is obliged to warn the doctor about the use of drugs, after which their temporary withdrawal or dosage adjustment will be required.
Medicines that are used in preparation for endoscopic retrograde cholangiopancreatography are drugs from the following list:
- "Atropine";
- Diphenhydramine;
- "Metacin";
- "Promedol";
- No-Shpa;
- Buscopan
- Sedatives, which are recommended to be taken a few days before the examination (for example, Novo-Passit).
The above funds are administered intramuscularly. They help reduce salivation, reduce contractility of the muscles of the gastrointestinal tract and pain.
It is important to remember that all medications should be used only after the appointment of a doctor. 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 laid on his left side.
- In most cases, local anesthesia using Lidocaine is used - they lubricate the throat to reduce painful and uncomfortable sensations during the introduction of the endoscope. Many people think that endoscopic retrograde cholangiopancreatography is a procedure that is performed under general anesthesia, but in fact it is not. Deep anesthesia is used only in cases where very painful and complex manipulations are expected.
- A mouthpiece is inserted into the oral cavity.
- 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. Promoting the device, a specialist examines the mucosa.
- Having reached the duodenum, the doctor launches air into its cavity, which inflates the walls of the organ for a more accessible study.
- Having found the duodenal papilla, the doctor inserts a special catheter into it, through which a contrast agent is introduced into the pancreatic and biliary tract.
- After filling all the ducts with a substance, x-rays are taken, which are displayed on the monitor, and sometimes printed.
- If it is necessary to carry out medical manipulations to determine the tumor, a biopsy instrument is introduced through the endoscope. Also, during the examination, it is possible to carry out a procedure to eliminate pathologies of the duodenal papilla.
- The doctor must inspect the walls of the investigated organ for the presence of active bleeding.
- Prevention of possible complications is 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 lasts about an hour on average.
Postoperative recommendations
It should be noted that after the examination, according to patients' reviews, painful sensations in the throat are observed for several days. Lollipops for sore throats can help in their elimination.
For some time after the procedure, it is necessary to follow a diet number 5, which excludes fried, salty, smoked food. It is forbidden to drink alcohol. Food should be mushy and comfortable in temperature. The duration of the diet will be determined by the attending physician.
Possible complications
Sometimes during the examination or after it, various complications can occur. This is due to the fact that endoscopic retrograde cholangiopancreatography is an invasive procedure. The most common hazardous effects 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, you must stay in the hospital for several days until this effect is 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 an injected contrast agent or anesthetic. The patient feels a headache, lack of air, dizziness, swelling of the mucous membranes and more.
- Cholangitis. Inflammation of the biliary tract. It may occur due to damage to the mucosa during the procedure, as well as infection in the examination.
- Purulent complications.
- Bleeding.
In addition to the above complications, other unpleasant consequences can also occur with endoscopic retrograde cholangiopancreatography - this is a feeling of a lump in the throat, heaviness in the stomach, flatulence, scratches of the pharynx, conjunctivitis and others.
If you experience a steady increase in temperature, vomiting with blood, paroxysmal pain in the abdomen, as well as throat bleeding, you should immediately consult a doctor. Procrastination in this case can cost a person life.
Patient Reviews
Patients in the appointment of the examination are interested in information about endoscopic retrograde cholangiopancreatography. What is it and what consequences should be expected, every patient should know. Many, having learned about the principle of the procedure, get scared and try to refuse this examination. But ERCP is a very important study in some diseases, it can not 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 benefit.
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 dangerous consequences.