Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is Endoscopic Retrograde Cholangiopancreatography (ERCP)?

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a specialised medical procedure available in Singapore for identifying bile duct obstruction, e.g., from bile duct stones. ERCP combines endoscopy and fluoroscopy to detect abnormalities such as blockages, stones, or other health-affecting conditions in these pathways.

Particularly beneficial for patients in Singapore with symptoms such as jaundice, severe abdominal pain, unexplained weight loss, or abnormal liver function blood tests, ERCP helps doctors pinpoint the root cause of these issues for targeted treatment.

While primarily a diagnostic tool, ERCP can also serve as a treatment method by addressing identified problems during the procedure.

How does Endoscopic Retrograde Cholangiopancreatography (ERCP) work in Singapore?

ERCP combines endoscopy technology and fluoroscopy – with endoscopy using a flexible tube with a camera to view your digestive system and fluoroscopy, a type of X-ray, to visualise internal structures.

During an ERCP, you will receive medication for relaxation and sedation, minimising discomfort and anxiety. To inspect for abnormalities, your specialist will guide the endoscope through your mouth, oesophagus, stomach, and duodenum.

A special dye is injected into the bile duct to enhance X-ray images and identify blockages or irregularities. If issues are found, immediate treatment, such as stone removal or stent placement, is possible through the procedure. ERCP serves both diagnostic and treatment purposes for digestive conditions.

After the procedure, you will be monitored as the sedation wears off. Temporary side effects, such as a sore throat, may occur but usually resolve quickly. Your specialist will discuss the findings and recommend further steps based on the findings and results. Following their instructions for preparation, diet, and medication adjustments is important for a smoother experience and recovery.

Benefits of Endoscopic Retrograde Cholangiopancreatography (ERCP)

• Minimally invasive: ERCP is a less invasive alternative to traditional surgery, leading to quicker recovery and less discomfort, especially for bile duct stones.
• Diagnostic and treatment: ERCP helps diagnose liver, bile ducts, and pancreas diseases and can be used to treat some of these conditions during the same procedure. 
• Relief from obstructions: ERCP is effective in identifying and treating blockages or obstructions in the bile or pancreatic ducts, such as those caused by gallstones, strictures, or tumours. By managing these blockages, ERCP can alleviate symptoms such as jaundice, pain, and infection.
• Stenting for improved flow: in cases where strictures or narrowing of the ducts are identified, ERCP allows for the placement of stents to improve flow through these ducts. This relieves pain, improves organ function, and prevents recurrent infections related to ductal obstructions.
• Prevents recurrence: for recurrent problems such as bile duct stones, ERCP with sphincterotomy (cutting off the muscle controlling bile flow) can help prevent future issues in patients unsuitable for surgery.
• Enhanced imaging: ERCP’s enhanced imaging capability allows for accurate diagnosis when other imaging modalities fail to diagnose.

What conditions can Endoscopic Retrograde Cholangiopancreatography (ERCP) treat/diagnose?

ERCP can be used to diagnose or treat the following conditions in Singapore:

• Gallstones in the bile duct
• Bile duct or pancreatic duct strictures
• Bile duct infections (cholangitis)
• Bile leak
• Periampullary cancer diagnosis (bile duct, pancreatic, or ampullary cancer)
• Jaundice
• Pancreatic duct stones
• Sphincter of Oddi dysfunction

What results can I expect from Endoscopic Retrograde Cholangiopancreatography (ERCP)?

The outcomes of ERCP depend on the procedure's purpose and typically fall into two categories: diagnostic and treatment outcomes.

Diagnostic outcomes include:

• Identifying blockage or narrowing: ERCP can identify blockages or narrowing in the bile or pancreatic ducts, potentially caused by stones, tumours, or inflammation.
• Detecting stones: ERCP is effective at detecting and locating gallstones that have passed from the gallbladder into the bile ducts.
• Diagnosis of tumours/biopsy: ERCP can help to diagnose tumours in the pancreas, bile ducts, or nearby areas. In some cases, biopsies or brushing can be conducted during the procedure for further analysis.

Treatment outcomes include:

• Stone removal: removing stones, such as bile duct stones, from the bile duct can alleviate symptoms like jaundice and prevent complications such as cholangitis or pancreatitis.
• Stent placement: for strictures or blockages, stents can be placed to keep the ducts open and ensure the flow of bile or pancreatic juices.

Most patients recover quickly from an ERCP and can usually return to their normal activities within 24 hours. However, it is important to watch for signs of possible complications, such as severe abdominal pain, fever, and/or jaundice. If you notice any of these, inform your doctor immediately.

The effectiveness of ERCP in alleviating symptoms or addressing the underlying condition depends on the specific issue at hand. In numerous instances, ERCP brings substantial relief and is crucial in managing intricate biliary tract problems.

How many Endoscopic Retrograde Cholangiopancreatography (ERCP) sessions are needed?

The number of ERCP sessions you may require varies based on the specific medical condition and treatment objectives. This can include your requirements, the complexity of the treated condition, and the response to initial interventions. For example, when using stents to address certain situations, it is generally noted that more than one ERCP session is needed to manage strictures and enhance outcomes effectively.

It is important to consult with your specialist for personalised advice and a treatment strategy before undergoing any procedure.

Frequently asked questions

Is ERCP painful?

During an ERCP procedure, you should not feel pain, as you will be given sedation to ensure your comfort. However, it is possible to experience some discomfort or a sore throat following the procedure.

Will I need to stay overnight after my ERCP, or is it an outpatient procedure?

ERCP procedures can typically be conducted on an outpatient basis, although in some instances, patients may require an overnight stay for observation, particularly following complex treatments.

How soon after the ERCP procedure can I eat or drink?

After the procedure, you can typically eat and drink a few hours later, once the sedation effects have subsided and upon your doctor's approval.

Are there any signs of complications I should watch out for after ERCP?

Yes, watch for severe abdominal pain, fever, chills, vomiting, dark urine, or jaundice. If you notice any of these symptoms, contact your doctor immediately.

If a stent is placed during my ERCP, will it need to be removed later?

Some stents are designed to be temporary and may require removal or replacement during a follow-up procedure, while others are intended for permanent placement.