Endoscopic retrograde cholangiopancreatography
The endoscopic retrograde cholangiopancreatography ( ERCP) is an endoscopic method can be performed with the diagnostic and therapeutic interventions. Besides the presentation of the bile ducts, gallbladder and pancreatic duct with X-ray contrast agent and Stones can be removed or the opening of the bile duct ( papilla of Vater ) are dilated. When endoscopic retrograde cholangiography (ERC ), for example, the pancreatic duct is not shown due to acute pancreatitis. The first ERCPs of children were carried out from 1977 to 1979 at the University of Bonn.
Implementation
With a by mouth ( orally ) introduced endoscope with sideview optics, the duodenoscope, the duodenum is identified and probed the papilla of vater, the mouth of the common excretory duct of the bile duct and pancreatic duct. The contrast agent is retrograde, ie, injected opposite to the normal direction of flow of bile in the biliary tract. Under the fluoroscopic X-rays are constrictions of gears, such as gallstones, biliary gravel or tumors assessed.
ERCP advantageous is the ability to treat at the same time in addition to the diagnosis, for example with the aid of an advanced through the working channel of the endoscope instrument for stone removal or destruction.
This is not possible advancement of instruments into the bile duct, the Papillenöffnung is a papillotome, a special catheter with a movable electrically charged wire, cut open. This process is referred to as endoscopic sphincterotomy executed (EPT ).
Therapeutically important is the ability to allow bile and pancreatic flow again at constrictions caused by tumors or inflammation caused by introduction of stent -called plastic or metal tubes. The bile duct is a cholangioscope which is advanced through the working channel of the endoscope, also be viewed directly. Furthermore, one can examine sonographically with an equally advanced through the working channel probe the bile duct, which is called intraductal ultrasound ( IDUS ).
In experienced hands, the risks are low. It can vary depending on the underlying disease to infection of the bile ducts or the gallbladder ( cholecystitis ), and air inlet in the biliary tract ( aerobilia ), inflammation of the pancreas ( pancreatitis) or for breach of the stomach or intestinal wall come.
Alternative methods for the diagnosis (but not for therapy ) are endoscopic ultrasonography and MRCP ( magnetic resonance cholangiopancreatography ).