ECRP (Endoscopic Retrograde Cholangiopancreatography)

Lita sits outside the clinic contemplating what the doctor has said. She still can’t believe it. All the while she thought it was just an ordinary stomach ache which she recurrently experiences. She thought she was fine and nothing was wrong. Little does she know there are little stones forming somewhere in her body. She is suspected to have gallstones and is scheduled for ECRP.

ECRP, what does that even mean? The doctor said it will be done to visualize the insides of the gallbladder, but she doesn’t really understand it. Will it be painful? What are the risks when doing it? A great wave of anxiety fills her as she thinks about what she will be going through. “I hope I can do this,” she says to herself as she stands up and heads out the door.

ECRP

ECRP or Endoscopic Retrograde Cholangiopancreatography is the procedure which combines upper gastrointestinal (GI) endoscopy thru the use of a thin, flexible, lighted scope called an endoscope and x-rays to treat problems of the bile and pancreatic ducts and may also be used to diagnose problems and examine the tubes that drain the liver, gallbladder and the pancreas.

Here, an endoscope is inserted by a doctor trained in endoscopy through the mouth and gently moved down the throat into the esophagus, stomach, and duodenum up to the point when it reaches where the pancreatic ducts and bile ducts drain into the duodenum.

Usually, it is done to check persistent abdominal pain or jaundice; find gallstones or diseases of the liver, bile ducts, or pancreas; remove gallstones from the common bile duct if they are causing a problem like obstruction; inflammation or infection of the common bile duct or cholangitis; or pancreatitis; open a narrowed bile duct or insert a drain; get a tissue sample for further testing or in other terms, biopsy; and measure the pressure inside the bile ducts such as in manometry.

Preparation

  • Usually, written instructions are provided to out-patients by health care providers which include fasting for at least 8 hours prior to the procedure.
  • The patient must also be advised not to smoke nor choke gum prior to ECRP.
  • The patient’s history must also be checked for heart and lung problems, diabetes, and allergies
  • All medications taken by the patient may also be noted
  • Patient may be advised to temporarily stop taking meds that may affect bloodclotting as they may interact with sedatives which will be given during the procedure. They may include nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen (Advil), and naproxen (Aleve); blood thinners; high blood pressure medication; diabetes medications; antidepressants and dietary supplements.

How it is done

Before the procedure, the patient may be given a local anesthetic which may be gargled or sprayed at the back of the throat to numb the throat and calm the gag reflex. Sedatives may also be given intravenously and vital signs will be closely monitored.

The patient then lies on the X-ray table as the doctor inserts an endoscope down the esophagus, through the stomach, and into the duodenum. Here, video is transmitted from a small camera attached to the endoscope to a computer screen within the doctor’s view and air is pumped through the endoscope to inflate the stomach and duodenum, which makes it easier for the doctor to do the examination.

After locating the duodenal papilla, a catheter is slid through the endoscope and guided through the papillary opening. The doctor then injects a dye/contrast into the ducts to allow the ducts to be seen on x rays. X rays are then taken to see the ducts and to look for narrowed areas or blockages.

Procedures to treat narrowed areas or blockages may also be performed during ERCP and Special tools that slide through the endoscope may allow the doctor to open blocked ducts, break up or remove gallstones, remove tumors in the ducts, or insert stents.

 

When performing this procedure, the health team must also take into consideration some risks such as infection, pancreatitis, allergic reaction to sedatives, excessive bleeding, puncture of the GI tract or ducts, tissue damage from radiation exposure, and, in rare yet grave circumstances, death.

 

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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