ERCP (endoscopic retrograde cholangiopancreatography)
Diseases of the liver and biliary tract are common among people very often, taking one of the first places in structure of diseases of the gastrointestinal tract. This has encouraged scientists and doctors to create a modern, efficient methods of assessment of the main bile duct and its tributaries. With this purpose, the most commonly used endoscopic retrograde cholangiopancreatography (ERCP), which is held in a large number of medical institutions. It is a kind of RPG, not requiring the use of endoscopic techniques. These procedures are performed in accordance with the available for their indications and contraindications, and also taking into account the requirements for preparing the patient for the procedure.
General description of the procedure
Endoscopic cholangiopancreatography is a highly efficient and safe method of examination of the biliary tract of the patient. The method consists in the following: using a special small endoscope is introduced into the ultimate divisions of the common bile duct in the duodenum, it introduced a special contrast agent. After that, a series of x-ray images using conventional radiography or by using computed tomography.
As with any diagnostic test, ERCP there are certain indications and contraindications to the use of the procedure. The indications include:
- The increased levels of bilirubin in the blood and the appearance of jaundice (yellowness of the skin and sclera) without established causes.
- Laboratory and clinical evidence of obstruction of the bile ducts or chronic disease.
- The precise localization and the course of biliary tract before surgical operations.
- Suspected tumor growth in the head of the pancreas or other adjacent organs with compression of the bile duct.
Contraindications to conduct cholangiopancreatography include: acute pancreatitis or cholecystitis (however, in recent years the procedure has been used very successfully for them), poor tolerability of drugs used to prepare patients for the procedure and a number of relative contraindications.
At presence at the patient of the indication for the operation RPG and lack of contraindications, the procedure is performed in a medical facility.
Preparations for the survey
Proper preparation of the research can significantly increase the efficiency of examination and reduce the risk of developing its complications. In preparation of the patient is recommended to refuse to eat for 10-12 hours before the procedure. It is necessary for the emptying of the duodenum and relaxation of the gallbladder and bile flow.
It is important to find out prior experience in conducting similar endoscopic studies and to identify possible intolerance to anesthetic and radiographic medicines.
The procedure is performed in a medical establishment. The evening before the study and immediately before him the patient is given a sedative, allowing you to calm the Central nervous system and relax muscle sphincters in the digestive tract. Also recommended for anesthesia of the mucous membrane of the pharynx to fight the gag reflex and reduce discomfort to the patient.
During the study, the patient is placed on his left side, and the left hand is placed behind him. After the endoscope will be opened into the duodenum, the patient turn over on your stomach as in this position most easily catheterizable the common bile duct. The average duration of study for 20-30 minutes depending on the tasks facing the doctor.
Compliance with these recommendations is shown in any application of these methods of examination.
The advantages and disadvantages of methods
Endoscopic examination of the biliary tract has a number of distinct advantages that distinguish it from similar diagnostic procedures:
- High diagnostic value associated with a visual control of the physician over the course of the procedure, with the ability to detect even minor changes in the biliary tract in the form of stenosis, inflammatory processes, etc.
- The possibility of simultaneous execution of surgical interventions through the endoscope in the form of removal of stones, stent to restore patency of the ducts with their stenosis, etc.
- When you use computed tomography it is possible to obtain three-dimensional images of the biliary system, facilitating the detection of stenosis, tumor and other three-dimensional processes.
Like all diagnostic methods have their advantages and disadvantages, is able to determine the possibility of application of the procedure in a specific patient.
However, this method of research has a number of limitations that prevent its widespread use:
- The possibility of trauma to the biliary tract with risk of development in which the inflammatory process and other complications.
- The necessity of the use of radiopaque substances that can cause some people allergic reactions.
Proper technique of the procedure and careful preparation of the patient allow to cope with the disadvantages of these types of diagnostics.
Failure to comply with the study Protocol or a particular patient can lead to the development of complications, the most common of which are:
- Acute pancreatitis, resulting from the negative impact of radiopaque substances into the ducts and the pancreatic tissue. In this case, activation of enzymes and the destruction of the body.
- Purulent inflammation such as cholangitis, can occur due to direct mechanical or chemical damage of the biliary tract.
- Bleeding from the biliary tract or duodenum, occur, usually, when trying to move the endoscope by force in the presence of stenosis or other obstacles. This is one of the most rare complications.
In connection with the possibility of rather severe complications you must carefully follow the technique of the procedure, adequate to handle the endoscope and other instruments and to avoid excessive application of mechanical force.
The use of endoscopic retroperitoneoscopy allowed to withdraw the diagnosis of diseases of the biliary tract to a new level, combining both visual inspection and the possibility of carrying out small surgical operations. ERCP and RPG are held in many diagnostic and therapeutic medical centers. The method competes with ultrasonic methods and other ways of visualization of the biliary tract. The procedure is based on established indications and contraindications, allows to avoid development of early and late complications.