Endoscopic retrograde cholangiopancreatography
The endoscopically (s) retrograde cholangiopancreatography ( ERCP ) is an endoscopic method that can be performed with the diagnostic and therapeutic interventions. In addition to showing the biliary tract , gall bladder and pancreatic duct with X-ray contrast media , stones can also be removed or the opening of the bile duct ( papilla vateri ) widened. When endoscopic retrograde cholangiography ( ERC ) is at an acute pancreatitis the pancreatic duct is not mitdargestellt. The first ERCPs on children were carried out from 1977 to 1979 at the University of Bonn.
execution
With an endoscope with side-view optics, the duodenoscope, inserted through the mouth (orally), the duodenum is visited and the Father's papilla , the mouth of the common duct of the bile duct and pancreatic duct , is probed . The contrast agent is injected into the biliary tract in a retrograde manner, i.e. against the normal direction of flow of the bile . Under X-ray fluoroscopy , narrowing of the ducts, for example due to gallstones , bile gravel or tumors , can be assessed.
The advantage of the ERCP is the possibility of simultaneous therapy in addition to diagnostics , for example with the aid of an instrument for stone removal or fragmentation that is advanced through the working channel of the endoscope. This involves removing gallstones that have slipped from the gallbladder into the bile duct and then become wedged at the narrow end in front of the papilla. This is done with a Dormia basket . If the stone is too big to pass through the cut or enlarged papilla, lithotripsy is carried out beforehand , either mechanically or with a laser.
If it is not possible to advance the instruments into the bile duct, the opening of the papillae is cut open with a papillotome , a special catheter with a movable, electrically charged wire. This process is known as an endoscopic papillotomy (EPT). Occasionally, the papilla opening is widened with a balloon instead.
In the case of constrictions caused by tumors or inflammation, the possibility of re-enabling the flow of bile and pancreas by inserting plastic or metal tubes called stents is therapeutically important . In addition, it is possible to take specific samples with forceps or brush instruments in order to confirm the suspicion of a tumor or inflammation with a tissue (histological) examination. The bile duct can also be viewed directly through a cholangioscope, which is advanced through the working channel of the endoscope (mother-baby technique). Furthermore, a probe that is also advanced through the working channel can be used to examine the bile duct sonographically, which is referred to as intraductal ultrasound (IDUS).
With a practiced hand, the risks are low. Depending on the underlying disease, infections of the biliary tract ( cholangitis ) or gall bladder ( cholecystitis ), air penetration into the biliary tract ( aerobilia ), inflammation of the pancreas ( pancreatitis ) or damage to the stomach or intestinal wall can occur.
An alternative procedure is PTC ( percutaneous transhepatic cholangiography ). It is usually carried out when ERCP is not possible. Other diagnostic methods (but not therapy) are endosonography and MRCP ( magnetic resonance cholangiopancreatography ).
Web links
- ERCP images. In: Endoscopy Atlas
Individual evidence
- ↑ German Med. Wschr. , July 1980, 30, 105, pp. 1055-1060
- ^ German Society for Digestive and Metabolic Diseases: Guideline Gallstone Diseases of the DGVS. In: DGVS website. DGVS, 2018, accessed January 13, 2018 .
