Ercp

an overview about ERCP procedure

1. Endoscopic retrograde cholangiopancreatography  ( ERCP ) Maryam Majid Al-Ezairej DEPARTMENT OF GENERAL SURGERY Collage of medicine, RAKMHSU

2. OBJECTIVES Define ERCP Describe its uses Outline briefly the procedure of ERCP Explain the advantages and disadvantages of ERCP Outline its complications, risk, and contraindication

3. WHAT IS ERCP ? Endoscopic retrograde cholangiopancreatography   is a technique that combines the use of  endoscopy  and  fluoroscopy  to diagnose and treat certain problems of the  biliary  or  pancreatic ductal  systems.

4. USES OF ERCP Ercp was first used n 1970s, at the time it was used for diagnostic purpose mainly but now a days it is used for both therapeutics as well as diagnostic although it is used for therapeutics more .

5. DIAGNOSTIC USES OF ERCP Obstructive jaundice Chronic  pancreatitis Gallstones with dilated bile ducts on  ultrasonography Bile duct tumors Pancreatic tumors Suspected injury to bile ducts either as a result of trauma or  iatrogenic

6. THERAPEUTIC USES OF ERCP 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)

7. BEFORE ERCP Before the patient undergoes the ercp several steps must be taken. CBC and clotting screening Respiratory and CVS assessment Prophylactic antibiotics should be administered to patient with biliary obstruction The patient should be fasting overnight

8. PROCEDURE OF ERCP The patient is under general anesthesia and lied on his left side A side-viewing duodenoscopy is passed through the pylorus and into the second part of duodenum to visualize ampulla of vater, it is then cannulated into it. By adjusting the angle of the endoscope it can be either cannulated into the common bile duct or into the pancreatic duct which is then visualized with a fluoroscopy.

9. ADVANTAGES OF ERCP Safe and highly effective diagnostic technique Accurate method of diagnosing and treating conditions of the bile and pancreatic ducts Simpler than exploratory surgery Can prevent the need for major abdominal surgery May help with planning for surgery

10. DISADVANTAGES OF ERCP: Complications rarely occur. Possible complications include bowel perforation or hemorrhage, which might require surgical repair or blood transfusion respectively Risk of perforation or hemorrhage is increased when polyps are removed via the endoscope The procedure requires a hospital stay Sedation is required, with a small risk of adverse reactions to medications used There is a degree of patient discomfort

11. COMPLICATIONS OF ERCP Pancreatitis (2-9%) is the most common complication of ercp Bleeding Infection even though it occurs it a very low rate Perforation rates with ERCP range from 0.1% to 0.6%.

12. Contraindication of ERCP ERCP is contraindicated in patients of : Acute pancreatitis Previous pancreatoduodenectomy Coagulation disorder if sphincterotomy planned Recent myocardial infarction history of contrast dye  anaphylaxis

13. REFERENCES www.slideshare.net emedicine.medscape.com www.medic8.com www.ddc.musc.edu

14. ANY QUESTION ? THANK YOU 