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ERCP is an important technique in the diagnosis and treatment of diseases of the pancreas and biliary tract<\/strong>, and it has been developing further in the last 40 years. In developed countries, the role of ERCP is increasingly shifting from a diagnostic procedure to a therapeutic one. During ERCP, a special endoscopy device called a duodenoscope with a side view, as thick as an index finger, bendable and light, is entered through the mouth, passing the esophagus, stomach and reaching the duodenum. Here, a structure called papilla with millimetric diameter is reached, where the bile duct and pancreatic duct open into the duodenum. The bile ducts are reached from the papilla with a thin plastic cannula called a catheter passing through the endoscope. Then, opaque material is given to the bile ducts and the biliary tract is visualized with an x-ray device. By looking at this image, abnormalities such as stones, tumors, and stenosis in the bile ducts are detected.[\/vc_column_text]<\/div> At least 8 hours of fasting is required before ERCP is performed. Oral anticoagulants should be discontinued 5-7 days before the procedure. If the patient has a pacemaker, necessary adjustments should be made for the pacemaker, again in line with the opinion of the cardiologist. Since radiation may be given during the ERCP procedure, female patients who are pregnant or likely to be pregnant should report this to their doctor. Although the processing time varies depending on the operation, it is 30 minutes on average, sometimes it can take up to 1-1.5 hours.[\/vc_column_text]<\/div> Presence of stones in the biliary tract<\/strong>:\u00a0If there is a stone in the biliary tract; With a different cannula with a wire at the end, the papilla, through which bile flows into the intestine, is cut by electrocautery (via a heated wire) and expanded (sphincterotomy). Then the basket or balloon catheter is passed through the endoscope, and the stone in the bile duct is caught by the basket or swept out by means of the balloon behind it. The success rate in stone removal during ERCP is approximately 95%. The probability of success is lower in patients with large, stuck stones, biliary stenosis, anatomical assumptions or patients with altered anatomy due to previous surgery. It needs additional materials and repetitive ERCP processes.<\/p>\n In cases where the stones in the biliary tract are together with the stones in the gallbladder, the stones in the biliary tract can be removed before, during or after the gallbladder surgery. ERCP should be performed before laparoscopic cholecystectomy (closed gallbladder surgery) if there is jaundice, elevated liver enzymes, elevated bilirubin, or progressive pancreatitis or cholangitis. ERCP is performed at an appropriate time after the operation for the treatment of bile duct stones that are detected during the gallbladder operation but not removed.[\/vc_column_text]<\/div> Stenosis in the bile ducts can be of 2 types. It may be a malignant stenosis due to a tumor in the bile ducts; There may also be benign strictures of the biliary tract, which may develop after previous bladder surgery, liver transplantation or hydatid cyst operation, and may develop due to chronic pancreatitis. It is difficult to make this distinction. The sensitivity of the pathological examination of the brush swab taken from the stenosis area during ERCP in making this distinction is low (30-57%). The sensitivity of cholangioscopy (which is entered into the bile ducts with a special endoscope) used in the diagnosis increases to 100%. In benign biliary strictures, the stenosis is treated by expanding the stenosis with a balloon or bougie and then inserting a small plastic tube called a plastic stent. These plastic stents are occluded in an average of 3 months and must be removed and reinserted when clogged. Generally, 55-88% success is achieved in biliary tract strictures that develop after 1 year of treatment. In cases that can be operated for malignant strictures caused by pancreatic head and biliary tract tumors, in special cases such as the presence of cholangitis in the patient, ERCP is performed before the operation and it is aimed to improve the patient’s clinical condition before the operation. In cases where surgery cannot be performed, the patient’s complaints such as jaundice and itching are relieved by inserting metallic stents, since they become occluded in a longer time compared to plastic stents (the average open time for covered metal stents is 1 year, and for bare metal stents it is 5-6 months).<\/p>\n For the treatment of biliary tract inflammation caused by malformations of the biliary tract such as choledochocele, choledochal cyst.[\/vc_column_text]<\/div> In the parasitic disease of the liver, also known as canine cyst, daughter cysts and germinative membrane that fall into the bile duct from the cyst can block the bile ducts. In this case, the obstruction in the bile ducts is removed by performing ERCP. Bile duct obstruction may develop due to parasitic diseases such as Fasciola hepatica or ascaris, and in this case, it can be treated with ERCP.[\/vc_column_text]<\/div> Although inflammation of the pancreas, called pancreatitis, can be seen at a rate of 1-7% after ERCP, this rate increases (20-30%) in the presence or suspicion of SOD dysfunction. Inflammation of the biliary tract called cholangitis (less than 1%), Inflammation of the gallbladder called cholecystitis (0.2-0.5%), Bleeding (0.8-2%), Intestinal perforation called perforation (0.1-0.6%), Painkillers used Allergic reactions that may develop against sedatives, spasm relievers and local drugs or opaque substances to be given, Emergency surgery requirement as a result of the stone or device getting stuck during stone removal, Heart and lung events (aspiration pneumonia, heart rhythm disorders)\u2026<\/p>\n As a result of these complications, emergency treatment may be required, some of them require surgery. The mortality rate associated with the ERCP procedure is 0.1-0.5%. Before ERCP, all patients are explained why this procedure was performed, the patient is informed about the complications that may be related to the procedure, and written consent is obtained from the patient.[\/vc_column_text]<\/div><\/div> [vc_row][vc_column][vc_column_text el_class=”aligncenter” css=”.vc_custom_1659121790905{margin-bottom: 20px !important;}”] biliary tract stone [\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":10026,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/opdrserdar.com\/en\/wp-json\/wp\/v2\/pages\/10121"}],"collection":[{"href":"https:\/\/opdrserdar.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/opdrserdar.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/opdrserdar.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/opdrserdar.com\/en\/wp-json\/wp\/v2\/comments?post=10121"}],"version-history":[{"count":3,"href":"https:\/\/opdrserdar.com\/en\/wp-json\/wp\/v2\/pages\/10121\/revisions"}],"predecessor-version":[{"id":10372,"href":"https:\/\/opdrserdar.com\/en\/wp-json\/wp\/v2\/pages\/10121\/revisions\/10372"}],"up":[{"embeddable":true,"href":"https:\/\/opdrserdar.com\/en\/wp-json\/wp\/v2\/pages\/10026"}],"wp:attachment":[{"href":"https:\/\/opdrserdar.com\/en\/wp-json\/wp\/v2\/media?parent=10121"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}What Should Be Done Before ERCP Is Performed?<\/h2>\n
In Which Situations Should ERCP Be Done?<\/h2>\n
Evaluation and Treatment of Stenosis in the Bile Tracts<\/h2>\n
Hydatid cyst<\/h2>\n
What Are ERCP Complications?<\/h2>\n