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What are possible ERCP treatments? PDF Print E-mail

If x-rays show a blockage of the papilla or the duct systems, the doctor may be able to treat it immediately.  Common treatments include sphincterotomy, balloon dilatation (stretching), stenting, and placement of drainage tubes.

 

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bullet_redSphincterotomy means cutting the muscular sphincter of the bile duct or pancreatic duct.  A small cut (about 1/4 inch long) is made in the papilla to enlarge the opening. This cut is made with electrical current (which you do not feel), so as to cauterize the tissues to prevent bleeding.

bullet_red Stone removal. The most common reason for performing a biliary sphincterotomy (cutting the opening of the bile duct) is to remove bile duct stones.  Although stones can pass spontaneously after a sphincterotomy into the duodenum (and through the intestines), doctors usually remove them directly at the same time using a basket-shaped grasper or by sweeping the duct with a small balloon on the end of a catheter.  Large stones may need to be crushed before removal, a technique called lithotripsy.  Special devices such as lasers may be needed occasionally to break particularly hard stones. Stones can also be removed from the pancreatic ducts, but they are often harder, and technically more difficult to remove.

bullet_redPapillary stenosis and sphincter dysfunction. Sphincterotomy (of the bile duct and/or pancreatic orifice) is used also when there is scarring of the papilla (papillary stenosis) or evidence of overactivity (spasm) of the muscular valve. This is called sphincter of oddi dysfunction. Sphincterotomy is more hazardous in this context than when used for stones.

bullet_redDuct dilatation and stenting. ERCP x-rays may show partial blockage or narrowing of the bile duct or pancreatic duct. This narrowing can be stretched (dilated) using a sausage shaped balloon catheter. Often a small tube (stent) is left behind to maintain the stretch, and allows the duct to drain more easily.

bullet_redNasobiliary drainage. Sometimes, instead of a plastic stent which stays in the duct, the doctor will choose to leave a longer tube for drainage after ERCP.  This is also placed through the endoscope during ERCP, but the end of the tube comes out through your nose after the procedure is finished.  The tube may be a little uncomfortable, but you will be able to eat and drink normally while it is in place (usually for one to three days).