Duodenoscopic image of two pigment stones extracted from common bile duct after sphincterotomy

Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. It is an x-ray examination of the bile ducts which is aided by a video endoscope. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x rays. Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... This article does not cite any references or sources. ... Bile, which is synthesized in the liver, is carried to the right and left hepatic ducts, which converge to form the common hepatic duct. ... Image File history File links Metadata Size of this preview: 584 × 599 pixelsFull resolution (776 × 796 pixel, file size: 92 KB, MIME type: image/jpeg) Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct. ... Image File history File links Metadata Size of this preview: 584 × 599 pixelsFull resolution (776 × 796 pixel, file size: 92 KB, MIME type: image/jpeg) Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct. ... Bile, which is synthesized in the liver, is carried to the right and left hepatic ducts, which converge to form the common hepatic duct. ... Choledocholithiasis is the presence of a gallstone in the common bile duct. ... Endoscopic images of a duodenal ulcer A flexible endoscope. ... A modern fluoroscope. ... X-Ray of the bile duct during a laprascopic cholecystectomy A bile duct is any of a number of long tube-like structures that carry bile. ... A duct joining the pancreas to the bile duct to supply pancreatic juice which aid in digestion provided by the exocrine pancreas. ...

Indications

ERCP is performed for diagnostic or therapeutic reasons. It is the Gold standard for recurrent pancreatitis. Pancreatitis is inflammation of the pancreas. ...

Diagnostic

• Obstructive jaundice - This may be due to several causes
• Chronic pancreatitis - a now controversial indication due to widespread availability of safer diagnostic modalities including endoscopic ultrasound, high-resolution CT, and MRI/MRCP
• Gallstones with dilated bile ducts on ultrasonography
• Bile duct tumors
• Suspected injury to bile ducts either as a result of trauma or iatrogenic
• Sphincter of Oddi dysfunction
• Pancreatic tumors no longer represent a valid diagnostic indication for ERCP unless they cause bile duct obstruction and jaundice. Endoscopic ultrasound represents a safer and more accurate diagnostic alternative

Jaundice, technically known as icterus, is yellowing of the skin, sclera (eyes) and mucous membranes caused by increased levels of bilirubin in the system. ... Pancreatitis is inflammation of the pancreas. ... Endoscopic ultrasound is an ultrasound that is placed into the stomach and duodenum via the upper GI tract. ... CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... MRCP is an imaging technique which detects biliary and pancreatic ducts in a non-invasive manner, moreover, after secretin stimulation, dynamic MRCP images of the pancreatic duct can be acquired. ... Medical ultrasonography is an ultrasound-based imaging diagnostic technique used to visualize internal organs, their size, structure and their pathological lesions. ... Cholangiocarcinoma is a cancer of the bile ducts, which drain bile from the liver into the small intestine. ... An iatrogenic (pronounced , IPA) condition is a state of ill health or adverse effect caused by medical treatment, usually due to mistakes made in treatment. ...

Therapeutic

• Any of the above when the following may become necessary
  • Endoscopic sphincterotomy (both of the biliary and the pancreatic sphincters)
  • Removal of stones
  • Insertion of stent(s)
  • Dilation of strictures (e.g. primary sclerosing cholangitis, anastomotic strictures after liver transplantation)

fuck u Sphincterotomy is formed from Sphincter + otomy (to cut, to separate). ...

Contraindications:

1. Absolute contraindication:
   • The uncooperative patient.
2. Contraindication
   • Recent attack of acute pancreatitis, within the past several weeks.
   • Recent myocardial infarction.
   • Inadequate surgical back-up
   • History of contrast dye anaphylaxis
3. Relative contraindications:
   • Poor health condition for surgery.
   • Severe cardiopulmonary disease.
   • Ascites.

Procedure

The patient is often sedated or anaesthetized. Then a flexible camera (endoscope) is inserted through the mouth, down the esophagus, into the stomach, through the pylorus into the duodenum where the ampulla of Vater (the opening of the common bile duct and pancreatic duct) exists. The sphincter of Oddi is a muscular valve that controls the opening of the ampulla. The region can be directly visualized with the endoscopic camera while various procedures are performed. A plastic catheter or cannula is inserted through the ampulla, and radiocontrast is injected into the bile ducts, and/or, pancreatic duct. Fluoroscopy is used to look for blockages, or leakage of bile into the peritoneum (the abdominal cavity). Endoscopy means looking inside and refers to looking inside the human body for medical reasons. ... From Greek pylorus; pyl- = gate, -orus = guard. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube connecting the stomach to the jejunum. ... The Ampulla of Vater is the part of the duodenum where the common bile duct empties into the second part of the duodenum, so named because it has the appearance of an ampulla. ... X-Ray of the bile duct during a laprascopic cholecystectomy A bile duct is any of a number of long tube-like structures that carry bile. ... The Sphincter of tOddi, also called the hepatopancreatic sphincter or Glissons sphincter, controls secretions from the liver, pancreas, and gallbladder into the duodenum of the small intestine. ... A modern fluoroscope. ... In higher vertebrates, the peritoneum is the serous membrane that forms the lining of the abdominal cavity - it covers most of the intra-abdominal organs. ...

A wire and balloon may be passed into the bile duct, then inflated in order to expand the opening of the bile duct to allow passage of gallstones. When needed, the opening of the ampulla can be enlarged with an electrified wire (sphincterotome) and access into the bile duct obtained so that gallstones may be removed or other therapy performed. In medicine, gallstones are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. ... In medicine, gallstones are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. ...

Other procedures associated with ERCP include the trawling of the common bile duct with a basket or balloon to remove gallstones and the insertion of a plastic stent to assist the drainage of bile. Also, the pancreatic duct can be cannulated and stents be inserted. The pancreatic duct requires visualisation in cases of pancreatitis. In medicine, gallstones are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. ... Endoscopic image of self-expanding metallic stent in esophagus, which was used to palliatively treat esophageal cancer. ...

Risks

Gut perforation is a risk of any endoscopic procedure as well as the ERCP holding a 5% risk of developing acute pancreatitis.

Dyes: Dyes used to allow the physician to image the organs can cause allergic reactions. Iodine is a component of one of these dyes, and if you are allergic to shellfish, you will be at risk with the dye. Also, the dyes can be harmful to the kidneys. If your kidneys have poor function, the dye could cause renal failure. If you are at such risk, then ask the physician, ask about how to promote flushing the dye from your system and how to recover from kidney damage. If you are on dialysis, you should be dialyzed after the procedure to flush out the dyes.

Sedation: Experienced anesthesia providers will provide you sedation only in an "as needed" amount to keep you comfortable. Oversedation can result in dangerously low blood pressure and nausea and vomiting. Nausea and vomiting are especially dangerous, as these prevent you from drinking to flush the dyes out of your kidneys. Anesthesia or anaesthesia (see spelling differences) has traditionally meant the condition of having the perception of pain and other sensations blocked. ...

References

• What is ERCP?. AGA Patient Center. American Gastroenterological Association. Retrieved on 2007-06-29.