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ERCP - Endoscopic Retrograde Surgery
Relevant information about ERCP - Endoscopic Retrograde Surgery.
- What does the surgery consist on
ERCP is an innovative method that combines the use of endoscopy and fluoroscopy for treating disorders of the biliary or pancreatic ductal system. The method consists on the use of an endoscope (that allows the professional to watch inside the patient´s body) and the injection of dyes into the affected organs that will allow the surgeon to see them by using X-ray.
- Which problem does the surgery solve
This technique can be used for many types of disorders, some of them are: obstructive jaundice, chronic pancreatitis, bile duct tumors, apparition of gallstones, suspected injury in the bile duct and finally, pancreatic tumors. ERCP will be a useful method for detecting any of the affections enumerated before. There are some patients that should not have an ERCP if they have gone through a recent attack of acute pancreatitis, poor conditions for having a surgery or severe diseases that affect the cardiovascular system.
- How is the surgery performed
First of all the patient will be sedated by using general anesthesia. Once the patient is completely numbed, the doctor will insert an endoscope through the mouth that will arrive to the duodenum, where the ampulla of vater is located. The images will be directly reproduced in a special monitor that will be located in the operating room. A plastic catheter (also called canula), will be inserted in the ampulla and dye will be injected into the bile ducts. The use of this substance is called fluoroscopy and allows the surgeon to search for gallstones or tumors. If the surgeon found gallstones, he/she will probably remove them in the same surgery, so the patient is free of any injury or disorder of this type. There are specific cases where the surgeon decides to use an additional camera that will be inserted through the channel of the first endoscope. This technique is called mother-daughter ERCP and is performed in cases where the situation of the patient requires a more sophisticated performance. The surgery is thought to be effective in the majority of the cases; the effectiveness of this operation is directly connected with the correct diagnosis of the disease or injury that the patient is having. Commonly, the surgeon defines which is the disorder and later, in another session talks with the patient in order to define how to treat the problem. Generally in severe cases such as the apparition of a tumor, the professional decides to make the removal a few months after the ERCP was performed.
- Surgery lenght: The procedure is estimated to last from one to two hours, depending in each case. In situations where the patient has gallstones, it is probable that the operation will last a little bit more because the surgeon may decide to make the removal the same day of the ERCP. In most of the clinics or hospitals where ERCP is performed, before entering to the operating room a group of nurses will make a few tests to the patient in order to determine if he/she is able to undergo the operation. They will take some examinations related to the blood pressure and his/her body temperature. The operation will be performed under general anesthesia; there have been very few cases where the professional decided to use local anesthesia. The patient will be able to leave the clinic the same day of the procedure, after the effect of the anesthesia has gone.
- How is the post surgery process
The post surgery process is neither complicated nor difficult. The patient will be able to resume his/her normal activities the following day of the procedure. There are some cases of elder patients where they prefer resting a few days until they are completely recovered. Among the normal activities we include, resuming work, driving, having sexual intercourse, etc. Doctors recommend not making physical activity or physical effort at least for one week after the procedure has taken place. There are few cases where patients feel pain or discomfort, when this occurs it is important for the patient to notify about the situation to the professional, he/she will suggest to have a prescript medication that will relief pain.
The main risk of having an ERCP is the development of a pancreatitis. According to statistics this occurs in a 5% of the patients who undergo an ERCP. Having a pancreatitis implies staying in the hospital for a specialized and additional care. Patients who are exposed to the risk of having a pancreatitis are younger patients or persons who have suffered previous post-ERCP pancreatitis. Other risk that must be considered is gut perforation, anyway this is not a specific complication that appears in ERCP, and gut perforation is possible to appear in every endoscopic procedure. If the patient is oversedated he/she could have as a consequence vomits, nausea, respiratory depression and low blood pressure. There are other risks that can appear as an adverse reaction to the anesthesia or to the dye. The anesthesiologist will have to make previous examinations in order to determine which substances could be dangerous for the patient if he/she is allergic. Infection is a problem that can be found in any surgical procedure, to avoid this there are several methods that include a right cleanness and keeping of personal hygiene and the use of antibiotics that help to avoid the formation of bacteria.
The surgery will positively affect the patient because it will help to define which kind of disease or medical disorder the patient is having. The doctor will be able to define in what way he/she will treat the problem. ERCP has been defined by professionals as one of the best methods of diagnosing illness in the pancreas.
- What does the surgery not do
The procedure will not remove any organ (with the exception of cases where the professional notices that it has been a formation of gallstone).
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