Retrograde cholangiopancreatography (ERCP). What is ERCP - description of diagnosis, preparation, indications and contraindications Endoscopic retrograde cholangiography

The pancreas is one of the most important digestive organs. Any of her illness requires immediate treatment. However, the cause of the malfunction of the pancreas and liver is rarely possible to determine the symptoms. Only a thorough examination can accurately determine the characteristics of the disease. The diagnosis is made only on the basis of the results of a comprehensive examination, which includes three main methods:

• Clinical. The doctor receives a general picture of symptoms based on the initial examination and questioning of patients. The main symptom of problems of the pancreas, liver, bile ducts is pain. They usually occur at the top of the abdomen and have different characteristics: prolonged or sharp, paroxysmal, give to the right or left side of the body. Pain is aggravated after eating certain foods: fried, fatty, smoked, spicy or alcoholic beverages.
• Laboratory. Laboratory examination will help determine the characteristics and stage of the course of the disease, the presence of inflammatory processes and other disorders of the body. For this, a blood and urine test is performed, a hemogram, a coprogram, tests for fermentation deficiency are prescribed.
• Instrumental. This method is necessary to confirm liver or pancreatic disease. With its help, you can visually assess changes in organs, the presence of extraneous formations. The list of instrumental methods includes endoscopic examination, abdominal x-ray, ultrasound, computed tomography, biopsy and types of cholangiopancreatography.

Cholangiopancreatography is a method for examining the bile and excretory ducts of the pancreas. It is carried out using an endoscope, x-ray and. Indications - diseases of the digestive system.

Types of examinations are distinguished depending on the equipment used and the features of the procedure.

Endoscopic retrograde cholangiopancreatography combines the use of an X-ray machine and an endoscope. With its help, it is possible to examine the upper and middle gastrointestinal tract. During the procedure, tissues are taken to determine the threat of malignant tumors, a sample of bile. It is possible to remove formations and excess bile from the gallbladder. It is possible to prescribe endoscopic retrograde cholangiopancreatography only if there are serious reasons, since an invasive procedure can cause complications. To make sure that ERCP is needed, the patient's condition and symptoms are monitored.

Indications and contraindications

An examination is most often prescribed to determine the cause of malaise with obstruction of the bile ducts. A symptom of impaired patency is abdominal pain, which indicates neoplasms in the gallbladder and ducts. Among other indications for the diagnosis of cholecystitis, cirrhosis of the liver, malignant tumors of the pancreas. ERCP also allows the doctor to prepare for surgery by examining the structural features of the ducts. Endoscopy devices can be used for surgical intervention during ERCP.

Endoscopic retrograde cholangiopancreatography is contraindicated in pregnancy, narrowing of the lumen of the esophagus or papilla of Vater, acute or exacerbation of the chronic form of inflammatory processes of the liver, bile ducts and pancreas, severe conditions of the cardiovascular and respiratory systems. Tell your doctor about the use of drugs and the presence of allergies.

The procedure is not possible if the subject has an intolerance to the substances necessary for the study. When using insulin and drugs that inhibit blood clotting, first reduce the dose, cancel the drug or replace it with analogues that do not interfere with the study.

Preparation for ERCP

To prepare for the procedure, do a cleansing douche. The study is carried out on an empty stomach, drinking is also not recommended. The patient is examined by medical workers. If the duodenum is normal, there are no contraindications, the anesthesiologist administers drugs. Endoscopy is a complex and painful procedure, so the use of sedatives is mandatory. Thirty minutes before the start of the study, solutions that reduce muscle spasms are used to ensure relaxation of the duodenum. For a more comfortable procedure, drugs are prescribed that minimize saliva secretion and a local anesthetic. The procedure lasts 30-40 minutes. If ERCP is expected to take longer, general anesthesia is possible.

Survey

The patient in the supine position is injected with an endoscope and a contrast agent, monitoring with x-rays. The endoscope through the oral cavity and esophagus is attached to the mouth of the major duodenal papilla. From there, an iodine-based contrast agent is injected into the common bile and pancreatic ducts through a catheter. After the systems are filled, pictures are taken. If stones or other formations are found on the images, special instruments are delivered to the duct and the formations are removed through the incision. At the end of the procedure, the contrast agent is removed from the body.

Side effects and complications

After the diagnosis, the patient spends several hours under observation to eliminate the risk of complications. The diagnostic process by ERCP does not have serious side effects, bloating and heaviness are possible. Pain in the throat caused by the endoscope can be disturbing for several days.

If during the procedure the removal of formations or the collection of tissues for analysis was performed, there may be a small amount of blood in the stool. When pain, chills, vomiting, and discoloration of feces are observed, consult a doctor. Intestinal infection, damage to the intestine or esophagus, bleeding, pancreatitis are possible.

Magnetic resonance cholangiopancreatography

The magnetic resonance method of research does not require the introduction of devices and iodine-containing contrast agents. An accurate three-dimensional image of the organs is obtained using magnetic fields and high frequency pulses. Non-contact examination is comfortable and does not give complications, while at the same time providing the necessary information about the structural features of the digestive system and the presence of pathology. MRCP is the most detailed method of research, in which you can study the features of the functioning of systems, identify changes hidden by bone tissues. However, magnetic resonance imaging does not allow you to see small stones and determine how narrow the duct is.

Research progress

Magnetic resonance cholangiopancreatography is performed for jaundice, pancreatitis, to clarify the cause of abdominal pain, to determine neoplasms and inflammation before surgery, or to evaluate the effectiveness of treatment.

Special preparation is not required, but it is necessary to refrain from food and liquid for several hours. Warn your doctor about the presence of diseases and allergies, as well as about surgery and pregnancy. The procedure lasts no more than fifteen minutes. If necessary, a contrast agent without iodine is injected through a vein. If the patient suffers from claustrophobia or anxiety, the doctor will prescribe a sedative. A prerequisite for successful MRI diagnostics is complete immobility. The patient is placed on a table and the position is fixed to help remain still. The patient is left alone in the office, but the radiologist monitors the progress of the examination and is in touch.

Contraindications and precautions

The examination is carried out under the influence of a powerful magnet. In order not to disrupt its work, it is forbidden to bring electronic devices, metal objects, jewelry into the office. It is also necessary to make sure that there is no metal in the body of the subject. Data distortion is caused by piercings, prostheses with metal parts, fillings, braces, metal brackets, stents. The difficulty may lie in the presence of implants. The effect of a magnet on some artificial devices in the body can be life threatening. It is possible to heat a tattoo made with a dye containing iron. Elevated body temperature in some parts of the body is normal. However, if the condition causes discomfort, it is necessary to inform the medical staff, since it is impossible to move and change position on your own. In working condition, the magnet buzzes, a knock is possible. To prevent sounds from disturbing the patient, you can ask for earplugs.

Limitations of using MRCP

The process takes place without consequences for the body, in some cases an allergic reaction to the contrast agent occurs. It is given through a catheter, which can be uncomfortable when inserted. It is advisable for women to refrain from breastfeeding after the procedure for a day. If side effects occur, contact your doctor. After the use of strong sedatives or sedatives, the patient remains under observation until full recovery.

This type of diagnosis is not possible or has limitations in some cases. Pregnant women are not recommended to conduct magnetic resonance cholangiopancreatography without urgent need, although no effect on the fetus has been identified. This method is also not suitable for diagnosing patients with serious injuries, in which fixators or medical devices cannot be removed from the body. An enclosed MRI machine can be cramped for obese patients. Some medical facilities have open scanners that will help solve the problem.

Diseases of the liver and biliary tract are very common among people, occupying one of the first places in the structure of diseases of the gastrointestinal tract. All this prompted scientists and doctors to create modern, highly effective methods for assessing the state of the main bile duct and its tributaries. For this purpose, endoscopic retrograde cholangiopancreatography (ERCP) is most often used, which is performed in a large number of medical institutions. Its variety is RPCH, which does not require the use of endoscopic equipment. These procedures are carried out in accordance with the indications and contraindications for them, as well as taking into account the requirements for preparing the patient for the procedure.

Endoscopic retrograde cholangiopancreatography

General description of the procedure

Endoscopic cholangiopancreatography is a highly effective and safe method for examining the patient's biliary tract. The method is as follows: using a special small endoscope inserted into the final sections of the common bile duct in the duodenum, a special contrast agent is injected into it. After that, a series of x-rays is taken using conventional x-rays or using computed tomography.

The used endoscope is equipped with a video camera and a light source, which allows the doctor to visually assess the condition of the stomach, duodenum, common bile duct, and also to identify pathological changes in its wall (inflammatory processes, growth of benign and malignant tumors, etc.).

An additional advantage of this method is the possibility of simultaneous endoscopic intervention aimed at removing stones from the duct, expanding areas with stenosis mechanically or with the help of stents, etc.

After the end of the procedure, the endoscope is removed, and the contrast agent comes out on its own along with the feces. Within a few hours after performing ERCP, it is recommended to monitor the patient, controlling his vital parameters.

Indications for ERCP

As with any diagnostic method, ERCP has certain indications and contraindications for using the procedure. The indications include:

• An increase in the level of bilirubin in the blood and the occurrence of jaundice (jaundice of the skin and sclera) without an established cause.

Skin icterus

• Laboratory and clinical data indicating obstruction of the bile ducts or their chronic disease.
• Clarification of the localization and course of the biliary tract before surgical operations.
• Suspicion of tumor growth in the head of the pancreas or other nearby organs with bile duct compression.

Contraindications to cholangiopancreatography include: acute pancreatitis or cholecystitis (however, recently the procedure has been successfully used for them), poor tolerance of drugs used to prepare the patient for the procedure, and a number of relative contraindications.

If the patient has indications for RPCG and there are no contraindications, the procedure is carried out in a medical institution.

Preparation for the survey

Proper preparation for the study can significantly increase the effectiveness of the examination and reduce the risk of its complications. As part of the preparation, the patient is advised to stop eating 10-12 hours before the procedure. This is necessary to empty the duodenum and relax the gallbladder and bile ducts.

ERCP is performed on an empty stomach

It is important to ascertain previous experience with such endoscopic examinations and to identify possible intolerance to anesthetic and radiographic drugs.

The procedure is carried out in a medical institution. In the evening before and immediately before the examination, the patient is given sedatives to calm the central nervous system and relax the muscle sphincters in the digestive tract. It is also recommended to perform anesthesia of the pharyngeal mucosa to combat the gag reflex and reduce the level of patient discomfort.

During the study, the patient is placed on the left side, and the left hand is placed behind his back. After the endoscope is inserted into the duodenum, the patient is turned over on the stomach, since in this position it is most easy to catheterize the common bile duct. The average duration of the study is 20-30 minutes, depending on the tasks facing the doctor.

Advantages and disadvantages of the technique

Endoscopic retrograde cholangiopancreatography has both pros and cons.

Endoscopic examination of the biliary tract has a number of specific advantages that distinguish it from similar diagnostic procedures:

• High diagnostic significance associated with the visual control of the attending physician over the course of the procedure, with the possibility of detecting even minor changes in the biliary tract in the form of stenosis, inflammation, etc.
• Possibility of simultaneous performance of surgical interventions through the endoscope in the form of removal of stones, installation of stents to restore the patency of the ducts in case of their stenosis, etc.
• When using computed tomography, it is possible to obtain volumetric images of the state of the biliary system, which facilitate the detection of stenosis, tumor and other volumetric processes.

Like any diagnostic methods, they have their advantages and disadvantages that can determine the possibility of using the procedure in a particular patient.

Scheme of ERCP

However, this research method also has a number of disadvantages that prevent its widespread use:

• The possibility of traumatizing the biliary tract with the risk of developing an inflammatory process and other complications in them.
• The need to use radiopaque agents, which can cause allergic reactions in some people.

The correct technique for performing the procedure and careful preparation of the patient make it possible to cope with the shortcomings of these types of diagnostics.

Possible Complications

Failure to comply with the study protocol or the characteristics of the patient's body can lead to the development of complications of the procedure, the most common of which are:

1. Acute pancreatitis resulting from the negative effects of a radiopaque substance on the ducts and tissue of the pancreas. In this case, enzymes are activated and the organ is destroyed.
2. Purulent-inflammatory processes, such as cholangitis, may result from direct mechanical or chemical damage to the biliary tract.
3. Bleeding from the biliary tract or duodenal wall usually occurs when trying to advance the endoscope by force in the presence of stenosis or other obstruction. This is one of the rarest complications.

Due to the possibility of developing rather severe complications, it is necessary to carefully monitor the technique of the procedure, properly handle the endoscope and other instruments, and avoid excessive application of mechanical force.

The use of endoscopic retropancreatocholangiography made it possible to bring the diagnosis of biliary tract diseases to a new qualitative level, combining both visual examination and the possibility of minor surgical operations. ERCP and RCP are performed in many diagnostic and treatment medical centers. The method successfully competes with ultrasound methods and other methods of visualization of the biliary tract. The use of this procedure, taking into account the established indications and contraindications, avoids the development of early and long-term complications.

ERCP (or ERCP) retrograde cholangiopancreatography (endoscopic) is a special technique for instrumental examination of the pancreas and bile ducts for pathologies. Each word, even each root, carries a specific informative value.

The main term "cholangiopancreatography" reports on the studied organs. Cholangio - gallbladder; "pancreato" - pancreas; “graphic” means that the data will be documented. Those. the result of ERCP is not just a medical opinion, but also x-rays that remain in the patient's medical history.

The unusual word "retrograde" means that the radiopaque substance used in the examination goes against the flow of bile and the secret secreted by the pancreas. And with "endoscopic" everything is more or less clear: the procedure is carried out using a thin flexible conductor with a camera and the necessary tools at the end.

Indications for ERCP

This type of diagnosis is quite specific, therefore it is not popular. But if a doctor prescribes ERCP to a patient, then there are certain indications for that. Just like that (for example, for prevention), the procedure is not carried out because of its high invasiveness.

Indications for ERCP may be as follows:

With the help of ERCP, you can not only determine the presence of pathology, but also find out its nuances. For example, the procedure allows you to assess the nature of fistulas, their number and composition of the content; see where the stones are localized and how large they are; establish the type of tumor, etc. That is, you can get a complete picture of the disease in order to decide on further treatment.

Endoscopic cholangiopancreatography is not performed if a person suffers from severe diseases of the heart and blood vessels, viral hepatitis, acute cholangitis, stenosis of the papilla of Vater. The procedure is also contraindicated for pregnant women.

How to prepare for ERCP

The examination is quite complex and responsible, so the patient must make every effort to prepare for it, so that the procedure itself takes place with minimal discomfort for him. Yes, and the effectiveness will also largely depend on how the body is prepared for ERCP.

The examination is usually scheduled in the morning, and the patient should not eat breakfast or even drink water. If you need to take some medications that you simply cannot do without (the need to take any medications before ERCP is discussed with your doctor), you can drink them with one sip of water. But if the last meal before ERCP should occur 8-10 hours before it, then you need to stop taking certain medications (in particular, blood thinners) a week before the scheduled examination.

By the way! It is necessary to inform the doctor in advance about regularly taken medications (insulin, to lower pressure, antibiotics, etc.), so that he can assess the need for taking them and combining them with the upcoming ERCP.

It is also advisable to come to the examination prepared. It is better not to wear contact lenses, jewelry and dentures, too. This will save time before the procedure. It is not recommended to come to the clinic by private transport, because after ERCP the patient is unlikely to be able to drive a car.

ERCP technique

The duration of the examination is approximately one hour, sometimes a little less. The patient must be prepared for discomfort and discomfort; he should listen to the doctor in everything and follow his recommendations.

Endoscopic retrograde cholangiopancreatography is performed under local anesthesia: the pharynx is treated with lidocaine (to facilitate the insertion of the endoscope). In addition, the patient is pre-injected with a sedative so that he is not nervous during the examination. In exceptional cases (if necessary, complex and painful medical manipulations), a person is given general anesthesia.

1. The endoscope is passed through the mouth and esophagus to the stomach. The doctor, advancing the instrument, simultaneously assesses the condition of the mucosa.
2. The "stop" of the endoscope is the duodenum, after which the bile duct begins. Having reached the organ, the doctor stops and starts air into its cavity. At the same time, a contrast agent is injected into the pancreas and bile ducts.
3. A series of x-rays are taken, which are immediately displayed on the monitor and, if necessary, then printed.
4. If ERCP is performed to determine the type of tumor, then a biopsy tool is inserted through the endoscope - taking a piece of tissue for analysis. In the same way, you can enter an instrument to remove a stone from the biliary tract.

The patient lies on his side during the procedure. Sometimes during the process, he may be asked to gently roll over on his stomach in order to better visualize the anatomical structures and get clearer pictures in different projections. After diagnostic ERCP, the patient is left in the clinic for 1-1.5 hours so that he can normalize his condition after the procedure and “move away” from sedatives. If therapeutic manipulations were performed during ERCP, the patient is placed in a hospital for a day.

Consequences and possible complications after ERCP

Feeling of a lump in the throat, damage to the pharynx (small scratches), nausea are common after retrograde cholangiopancreatography. Someone also develops flatulence and feels heaviness in the stomach. All this is short-term and not critical. The presence of a small amount of blood in the first feces after the examination is explained by a slight damage to the tissues of the mucous membrane when they are taken for analysis (biopsy).

Another thing is an increase in body temperature after ERCP. This indicates an infection and the need to urgently consult a doctor. The reason for calling an ambulance should also be throat bleeding, acute paroxysmal pain in the abdomen, black stools, vomiting with blood.

According to statistics, complications after retrograde cholangiopancreatography occur in 11 cases out of a hundred. Of these, about two-thirds is developed pancreatitis. But this does not mean that the disease appeared due to ERCP: it would have developed sooner or later, but the examination simply accelerated this process. Rarely, cholangitis or cholecystitis may develop. And all these diseases will be easier to treat, because the doctor will already have a complete picture of the state of the pancreas and ducts.

By the way! Only 1% of complications occur in cases associated with improper ERCP technique. This may be a doctor's mistake: too fast insertion of the endoscope, lack of pre-treatment of the instrument, etc. And sometimes it is the fault of the patient who did not follow the medical recommendations before or during the examination.

Despite some difficulties in preparing for and conducting ERCP, sometimes this is the only way to fully examine the pancreas. And MRI, ultrasound and other alternative, less invasive techniques may not always give an accurate picture of the patient's condition. Therefore, it is not necessary to refuse retrograde cholangiopancreatography, if it is prescribed by a specialist. You just need to conscientiously prepare for the procedure, and then everything will go fine.

Endoscopic retrograde cholangiopancreatography (ERCP) - used to diagnose various pathological conditions of the pancreato-biliary system, including tumors, choledocholithiasis, etc.

Tools:

Endoscope with lateral optics,

For cannulation of the OBD, standard catheters are used,

x-ray unit, which makes it possible to perform both X-rays and fluoroscopy

Methodology:

Premedication

Adequate preparation, premedication and anesthesia are the guarantor of the study. Premedication must necessarily include drugs that cause relaxation of the duodenum (benzogexonium, metacin, narcotic analgesics, antispasmodics).

The patient is placed on the X-ray table, on the left side (as with standard EGDS). After passing through the pylorus, a detailed examination of the duodenum begins. The longitudinal fold serves as a reference point for the search for BDS. OBD can vary greatly in size, shape and appearance. Most often, it has a brighter color and a rougher surface than the surrounding mucosa. Before cannulation, the catheter must be pre-filled with saline to prevent air from entering the contrast ducts. A lift is used to position the catheter in the correct position. After performing cannulation, it is necessary to determine in which of the ducts, bile or pancreatic, the catheter is located. To do this, a small volume (3-5 ml) of a contrast agent is injected and fluoroscopy is performed. For contrasting the biliary tract, water-soluble contrast agents are used at a concentration not exceeding 30-50%. The contrast agent should be injected under fluoroscopy guidance. If ERCP is performed correctly and there are no obstructions, the choledochus, gallbladder, common hepatic and intrahepatic ducts should be filled.

Indications:

The need to identify the cause of obstructive jaundice;

Postcholecystectomy syndrome;

Planned papillosphincterotomy;

Suspicion of a tumor and other changes in the head of the pancreas;

Intolerance to radiopaque drugs when they are in / in the introduction.

Contraindications:

General contraindications to fibroduodenoscopy;

Acute pancreatitis;

Pseudocysts of the pancreas;

infectious hepatitis;

Inflammatory diseases of the bile ducts with septic complications.

Papillosphincterotomy (EPST) - This is a minimally invasive operation that allows you to eliminate the pathology of the major duodenal papilla and remove stones from the bile ducts in choledocholithiasis, both primary and PCES

Tools:

Duodenoscope with a diameter of the instrumental channel of at least 2.8 mm, a source of diathermic current, an X-ray machine, papillotomes of various designs,

sphincterotome,

Methodology:

During EPST, the patient should be adequately sedated. For this purpose, in addition to drugs that suppress peristalsis (atropine, metacin, benzohexonium), patients are prescribed Relanium in combination with narcotic analgesics or propofol. For prophylactic purposes, sandostatin and antibiotics can be prescribed before manipulation.

The technical implementation of EPST and the success of the procedure are determined by knowledge of the anatomy of the pyloroduodenal region, especially the sphincter apparatus. The lower, middle, and also part of the upper sphincters are subject to dissection. Dissection of the BDS is performed by cannulation and non-cannulation methods.

The cannulation method involves the introduction of a papillotome into the mouth of the papilla ampulla. The most important role in conducting EPST is played by the correct orientation of the cutting string of the papillotome. The string should be placed in the BDS for 11-1 hours. Only a small part of it should be in contact with the tissues at each moment of dissection. With a large mass of tissues in contact with the string, the supplied current is dissipated, and its strength becomes insufficient to cut the tissues. With the help of a lift, as a rule, it is possible to achieve adequate contact of the string with the tissues during dissection. The dissection is carried out by a series of short pulses with a duration of 1-2 with a mixed current (cutting / coagulation) with a predominance of cutting in a ratio of 1/3 or 2/3. The incision for EPST should not go beyond the bulging of the duodenal wall, which is a projection of the passage of the intramural part of the choledochus. Longitudinal fold, located on the border of the junction of the wall of the duodenum and intramu-

ral part of the common bile duct, can serve as a guideline for the maximum length of the incision.

The non-cannulation method is used in cases where cannulation of the OBD is impossible or unsuccessful. This usually occurs with an impacted stone and obstructive stenosis. This technique is called suprapapillary choledochoduodenotomy. The purpose of performing EPST is to restore an adequate outflow of bile, while the size of the stoma should be equal to the diameter of the common bile duct.

Indications:

Choledocholithiasis in patients with a removed gallbladder or in the absence of calculi in the gallbladder;

Choledocholithiasis, accompanied by obstructive jaundice;

Acute biliopancreatitis caused by a stone in the distal choledochus (with a wedged stone, EPST is performed urgently);

Benign papillostenosis;

OBD cancer with a high risk of palliative or radical surgery at the height of jaundice.

Contraindications:

Extended stenosis of the common bile duct;

Anatomical features of the choledochoduodenal region (location of the BDS in the diverticulum, etc.);

The presence of stricture of the proximal choledochus. Common ones include:

Coronary and pulmonary heart failure;

Stroke (acute stage);

Violations of the coagulating properties of the blood;

Biliary cirrhosis of the liver;

Severe duodenostasis;

Destructive pancreatitis;

Severe somatic pathology (acute stage of myocardial infarction, diabetes, hypertension III stage, etc.).

A technique involving endoscopic and fluoroscopic examination is called retrograde cholangiopancreatography or ERCP. This procedure is intended to be able to check the condition of the following organs: the gallbladder, bile ducts, liver, and pancreas. The ERPH procedure allows you to examine these organs and identify abnormalities. The basis of such a study is a specialized device called an endoscope. It is an elastic tube that is inserted through the mouth and pulled through the stomach to the ducts in the duodenum. Through the introduced elastic tube, a contrast agent is supplied, after which X-ray equipment is used.

In what cases is the procedure indicated

Endoscopic retrograde cholangiopancreatography is prescribed by the attending physician if the patient has the following indications:

1. The presence of suspicion of obstruction of the ducts. The causes of obstruction of the ducts can occur through blockage of the channels or with the development of chronic diseases of the gastrointestinal tract.
2. Chronic pancreatitis.
3. Unclear reasons for the development of jaundice.
4. The presence of a tumor or suspicion of neoplasms.
5. Suspicion of damage to the ducts after surgical interventions.

The endoscopic examination procedure is also prescribed to diagnose other types of diseases of the digestive system. Before the doctor prescribes a study, he will need to examine the patient, interview, check for relevant symptoms and read the medical history. The ERCP procedure is prescribed not only to detect diseases, but also to make sure that the treatment is effective and that there are no other pathologies in the digestive system.

How to prepare for the study

The procedure of pancreatocholangiography is performed exclusively on an empty stomach. Eating is prohibited 12 hours before the study. Food accumulates in the stomach, which leads to a deterioration in the study. In addition, if there is food in the stomach, then at the time of swallowing the probe, gag reflexes will develop, which will lead to the removal of food residues.

On the eve of the study, it is forbidden to eat heavy food for 2-3 days, and switch exclusively to light food. It is necessary to give preference to liquid types of food: broths, kefir, yogurts, milk porridges. It is not recommended to consume fresh fruits and vegetables, as they are enriched with fiber, which takes a long time to digest. On the evening before the study, you can eat no later than 18.00 hours. You can't eat or drink in the morning.

The study of cholangiopancreatography is carried out directly in the hospital, for which a room with the necessary equipment should be specially equipped. If the patient comes to the procedure unprepared, the doctor may cancel the study.

It's important to know! Performing an endoscopic procedure without prior preparation is quite dangerous, as this can cause damage to internal organs.

On the eve of the study, the doctor warns the patient about the possible complications and dangers of the procedure. The patient is also required to give written consent to conduct this type of study. Before proceeding with the procedure, it is necessary to achieve relaxation of the duodenum. If intestinal motility persists, then it will simply not be possible to penetrate into the necessary area for the examination.

It's important to know! To avoid unforeseen consequences during the course of the study, the doctor may require the patient to take some tests.

What is the research technique using an endoscope and X-ray, we will find out further.

How is ERPH performed?

After the patient is ready for the examination, the nurse will give a sedative injection, which will get rid of excessive excitement. The oral cavity is treated with local anesthetics, which allows you to suppress the development of gag reflexes when the probe is inserted.

The probe is inserted through the mouth, after which it passes through the esophagus and stomach, and then reaches the duodenum. The progress of the probe is controlled by a specialist who observes all manipulations on the monitor.

It's important to know! The procedure is performed with the patient lying on the left side.

When the probe reaches the duodenal nipple, another tube is pulled inside the endoscope, from which a contrast agent is injected.

It's important to know! The endoscope should take a position in close proximity to the duodenal papilla.

The contrast agent is intended for X-ray examination. After that, the doctor uses an X-ray machine, through which the condition of the ducts is determined, as well as the presence of stones and various neoplasms.

During the study, if necessary, an operation can be performed, for which special surgical instruments are inserted through a special channel of the device. Often, such an operation is the removal of various narrowings or neoplasms. If it is necessary to remove bile, then the doctor inserts a catheter during the study, with the help of which the substance is taken. After the end of all manipulations, the doctor slowly removes the probe from the digestive system. The duration of the diagnosis does not exceed 10-15 minutes, but if treatment is required, the duration of the intervention can reach 30-40 minutes.

Features of the use of a contrast solution

The contrast solution allows you to get a high-quality radiograph, so its role in the procedure is the main one. Before performing ERPH, the specialist must prepare a contrast agent. In order to carry out the cholangiography procedure, about 30-40 ml of solution will be required. Pancreatography will require no more than 5-10 ml of solution.

It's important to know! During the study, the doctor should have distilled water on hand, which will allow you to change the concentration of radiopaque substances.

Contrasting of the pancreatic duct is carried out under the strict supervision of a specialist. If, when contrasting the pancreatic duct, the volume exceeds 10 ml, this will lead to the filling of the acini, which will lead to the development of acute pancreatitis. After X-ray examination, the substance is excreted for 40-60 seconds. To avoid unforeseen effects on the pancreas, the contrast medium is aspirated. Contrast agents are removed from the bile ducts very slowly, so the specialist has time to take an x-ray in various positions.

Advantages and disadvantages of the technique

Retrograde pancreatocholangiography has one significant advantage - it is the ability to obtain the maximum amount of information about the state of the ducts. Through this technique, it is possible to diagnose the presence of diseases. Using this method, a specialist with maximum accuracy can determine difficult places, narrowings and stones in the ducts.

Another advantage of the technique can be called the possibility of surgical intervention in the shortest possible time. With the help of special equipment, the doctor can carry out the procedure for removing stones, freeing the ducts from bile, and even install stands in order to eliminate the cause of the obstruction. After the procedure, the patient returns to a full life in the shortest possible time.

This technique also has a significant drawback - the possible risks of developing complications after the study. If complications arise during the diagnosis or surgery, this will lead to the need to re-intervention. To avoid the development of complications, the patient must come to the study prepared, and the procedure should be carried out exclusively by an experienced and qualified specialist.
In conclusion, it is worth noting that the cost of this method is from 10,000 rubles. Patients who are indicated for this technique must undergo a study in order to avoid the development of unforeseen complications.