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Endoscopic retrograde cholangiopancreatography, or ERCP, is a medical procedure used in the diagnosis and treatment of problems which involve the tubes, or ducts, that lead out of the pancreas and gall bladder. An ERCP with sphincterotomy involves making a bigger opening in one of the ducts, perhaps to allow the removal of a gallstone, for example. During the procedure, an endoscope, a long, slender instrument with a camera attached, is used to view the ducts and to inject a special dye into them. This dye shows up on X-rays which are taken at the same time, revealing the outlines of the ducts in detail. A gallstone wedged inside the bile duct which drains the gallbladder can then be located, and may be treated using tools attached to the endoscope.
An ERCP with sphincterotomy may be carried out using only a local anesthetic, so the patient is able to stay awake. Usually, a sedative is given to relax the patient and to minimize discomfort during the endoscopy. It is often possible to return home on the same day as the procedure.
At the beginning of the ERCP, an endoscope is passed into the mouth, down past the stomach and into the section of gut called the duodenum. Here, ducts from the pancreas and gall bladder join together and open into the duodenum through a valve. The valve is a hole with a circle of muscle around it, known as the sphincter of Oddi. A channel in the endoscope is used to inject dye into the ductal systems through the sphincter, and X-ray images are taken simultaneously, allowing the bile duct and pancreatic duct to be assessed.
If a gallstone is found to be located inside the bile duct, sphincterotomy may be required. Sphincterotomy involves making a small cut in the ring of muscle that forms the sphincter of Oddi. This serves to enlarge the opening of the sphincter, and special instruments attached to the endoscope may then be used to draw a stone, or stones, out of the duct and into the gut. Sometimes it may be necessary to break up a large stone to extract it.
ERCP with sphincterotomy may be performed to treat conditions other than gallstones. Sometimes the sphincter of Oddi may not function properly and might fail to open, causing digestive juices to build up and leading to possible complications such as inflammation of the pancreas, or pancreatitis. A sphincterotomy may become necessary in severe cases. Sphincterotomy may also be carried out when doctors want to widen narrowed ducts by inserting short lengths of tubing known as stents. Although, in most cases, ERCP with sphincterotomy does not lead to any complications, occasionally problems such as chest infections or internal bleeding can occur.