ERCP is a procedure that doctors use to diagnose and sometimes treat a blockage or restriction of the pancreatic or bile ducts. During an ERCP, a tube is inserted into the patient’s mouth, and then passed through the esophagus, stomach, and into the opening of the small intestine. Therapeutic ERCP occurs when the issue is diagnosed and it is determined that a procedure can be performed, using the already-inserted tube.
Therapeutic ERCP is common, as doctors have begun to limit the use of ERCP for diagnostic purposes unless it is suspected that treatment can immediately follow. While being less invasive than most therapeutic remedies, ERCP carries higher risk factors than most diagnostic procedures.
Types of ERCP Treatments
The type of ERCP treatment to be performed is contingent upon the reason for blockage. Causes of blockage include: inflammation due to infection, cancerous or non-cancerous tumors, gallstones, and accumulations of tissue. The most effective form of ERCP treatment can vary greatly from case to case. ERCP treatments include balloon dilation, sphincterotomy, removal of stones from ducts, and stents.
Balloon dilation is used to stretch narrowing in the ducts in order to allow the flow of the bile or pancreatic fluid. Catheters are fitted with the balloons, and then ran through the area that is narrowed. Narrowing can be due to malignant growth or scarring. The balloon is then inflated, widening the opening. Stents are sometimes temporarily inserted for reinforcement.
Stents are also used to bypass blockages that are considered dangerous or unnecessary to remove. A plastic or metal stent can be used. A plastic stent is temporary, and resembles a straw. A metal stent is permanent, and is made of flexible metal wires. In most cases, further surgery or subsequent ERCP is required to drain or remove the stent.
A schincterotomy is also known as an ERS, or endoscopic retrograde sphincterotomy. This ERCP treatment is typically performed when gallstones are found in the bile duct. An electric knife is used to cut the very end of the bile duct, at the ampulla. The gallstones can then be removed. This usually occurs in the bile duct, but occasionally an ERS is performed to alleviate a blockage in the pancreatic duct.
Stone removal is most often done after an ERS has been performed to enlarge the opening of the bile duct. Tools known as balloons and baskets are moved through the endoscopic tube and used to push the obstructing stone through the sphincterotomy and into the bowel. Sometimes a stone may have to be crushed using the basket in order to fit.
Biopsies are also considered a form of therapeutic ERCP. Although not a definitive treatment for the tumor or obstruction, performing a biopsy during an ERCP allows the surgeon access to the tissue that needs to be analyzed for cancer. This eliminates the need for more invasive surgery that would be necessary otherwise.
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