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    Kuliah Blok GI Tract-ERCP, Agustus 2010

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    Hendry
    ERCP (Endoscopic Retrograde Cholangio Pancreatography) is an endoscopic procedure that uses x-rays to image the bile ducts and pancreas. A thin, flexible endoscope is inserted through the mouth to inject contrast dye to visualize the ducts. It is used to diagnose and treat conditions like gallstones in the bile ducts, blockages, jaundice, abdominal pain, and cancers. The basic procedure involves anesthetizing the throat, inserting the endoscope, injecting contrast dye, and taking x-rays. Potential risks include bleeding, intestinal perforation, and pancreatitis, though serious risks are uncommon.

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    Kuliah Blok GI Tract-ERCP, Agustus 2010

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    Hendry
    21 views15 pages
    ERCP (Endoscopic Retrograde Cholangio Pancreatography) is an endoscopic procedure that uses x-rays to image the bile ducts and pancreas. A thin, flexible endoscope is inserted through the mouth to inject contrast dye to visualize the ducts. It is used to diagnose and treat conditions like gallstones in the bile ducts, blockages, jaundice, abdominal pain, and cancers. The basic procedure involves anesthetizing the throat, inserting the endoscope, injecting contrast dye, and taking x-rays. Potential risks include bleeding, intestinal perforation, and pancreatitis, though serious risks are uncommon.

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    Kuliah Blok GI Tract-ERCP , Agustus 2010

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    ERCP (Endoscopic Retrograde Cholangio Pancreatography) is an endoscopic procedure that uses x-rays to image the bile ducts and pancreas. A thin, flexible endoscope is inserted through the mouth to inject contrast dye to visualize the ducts. It is used to diagnose and treat conditions like gallstones in the bile ducts, blockages, jaundice, abdominal pain, and cancers. The basic procedure involves anesthetizing the throat, inserting the endoscope, injecting contrast dye, and taking x-rays. Potential risks include bleeding, intestinal perforation, and pancreatitis, though serious risks are uncommon.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    21 views15 pages

    Kuliah Blok GI Tract-ERCP, Agustus 2010

    Uploaded by

    Hendry
    ERCP (Endoscopic Retrograde Cholangio Pancreatography) is an endoscopic procedure that uses x-rays to image the bile ducts and pancreas. A thin, flexible endoscope is inserted through the mouth to inject contrast dye to visualize the ducts. It is used to diagnose and treat conditions like gallstones in the bile ducts, blockages, jaundice, abdominal pain, and cancers. The basic procedure involves anesthetizing the throat, inserting the endoscope, injecting contrast dye, and taking x-rays. Potential risks include bleeding, intestinal perforation, and pancreatitis, though serious risks are uncommon.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 15

    Endoscopic, Retrograde Cholangio Pancreatography/ERCP

    Dr. Yanto Budiman, Sp.Rad., M.Kes Bagian Radiologi FK/RS Atma Jaya Jakarta

    ERCP
    Endoscopic, Retrograde Cholangio Pancreatography Endoscopic :use of an instrument called an endoscope - a thin, flexible tube with a tiny video camera and light on the end. Retrograde :The direction in which the endoscope is used to inject a liquid enabling X-rays to be taken of the parts of the GI tract called the bile duct system and pancreas. The process of taking these X-rays is known as cholangiopancreatography. Cholangiopancreaticography :Imaging the bile duct system, and pancreas.

    Indications for imaging


    Gallstones, which are trapped in the main bile duct
    Blockage of the bile duct Jaundice Undiagnosed upper-abdominal pain Cancer of the bile ducts or pancreas Pancreatitis

    When pancreatitis is caused by gallstones, it is necessary to remove the gallbladder. At times, an ERCP (Endoscopic Retrograde CholangioPancreatography) test is recommended. This involves passing a flexible tube through the mouth and down to the small intestine. A small catheter is then inserted into the bile duct to see if any stones are present. If so, they are then removed with the scope.

    Preparations
    Patients should ingest no solids for at least 6-7 hours and

    no liquids for at least four hours prior to the procedure. For some procedures, topical pharyngeal anesthesia alone is sufficient, especially when the endoscopy is performed with a small diameter endoscope. For prolonged examinations, those in children, or in patients with a high degree of anxiety, rapid onset sedatives and/or analgesics are often necessary. Anticholinergics (e.g., atropine) have been given to decrease saliva, gastric secretions and motility, and reduce the likelihood of vasovagal reactions; For procedures in which paresis of gastroduodenal motility is necessary, parenteral glucagon may be useful

    Basic Procedure
    The throat is anesthetized with a spray or solution The endoscope is then gently inserted into the upper esophagus. The

    patient breathes easily throughout the exam, with gagging rarely occurring. A thin tube is inserted through the endoscope to the main bile duct entering the duodenum. Contrast media is then injected into this bile duct and/or the pancreatic duct and x-ray films are taken. The patient lies on his or her left side and then turns onto the stomach to allow complete visualization of the ducts. If a gallstone is found, steps may be taken to remove it. If the duct has become narrowed, an incision can be made using electrocautery (electrical heat) to relieve the blockage, it is possible to widen narrowed ducts and to place small tubing, called stents, The exam takes from 20 to 40

    Side Effects and Risks


    A temporary, mild sore throat sometimes occurs after the

    exam. Serious risks with ERCP are uncommon. One such risk is excessive bleeding, especially when electrocautery is used to open a blocked duct. In rare instances, a perforation or tear in the intestinal wall can occur. Inflammation of the pancreas also can develop. There is also a small risk of an allergic reaction to the dye, which contains iodine. Rarely, drugs used to relax the ampulla of Vater can have side effects such as nausea, dry mouth, flushing, urinary retention, rapid heart rate (sinus or supraventricular tachycardia), or a drop in blood pressure Due to the mild sedation, the patient should not drive or operate machinery for six hours following the exam.

    Contrast Media

    20 ml non-ionic/low-osmolality 200 mg/ml contrast media

    ERCP

    Magnetic resonance cholangiopancreatography (MRCP)


    When compared to ERCP or PTC the accuracy is very similar. MRCP has a sensitivity and specificity of 91% and 98% respectively for choledocholithiasis . Its accuracy for benign and malignant obstruction is 90%. Does not carry the 5 - 30% failure rate associated with ERCP . It is also spares the morbidity (1-7%) and mortality (0.2-1%) of ERCP and is twice as cost effective .

    The disadvantage is that it is solely a diagnostic test.


    It should not be used in choledocholithiasis when there is a high likelihood of a CBD stone. In this situation ERCP would be indicated since endobiliary therapy can also be carried out. MRCP is not the initial investigation of choice in

    cholecystitis as ultrasound is just as accurate and much more cost effectiv

    THANK YOU

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