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ERCP, which stands for endoscopic retrograde cholangiopancreatography, involves using an endoscope to perform imaging of the pancreatic and bile ducts. This procedure is a highly specialized, minimally invasive surgery that requires a high degree of skill and proficiency. Compared to traditional surgery, ERCP surgery has the advantages of minimal trauma, fast recovery, and precise treatment, and can serve both diagnostic and therapeutic functions. As such, it is considered the "crown jewel of digestive endoscopy" in the industry and is often dubbed the "diamond" of medical technologies.
The basic operating procedure involves inserting a endoscope, similar to a gastroscopy, into the mouth and advancing it into the mid-segment of the duodenum, where the exit of the common bile duct is located. From there, a specialized guide wire and professional tools are inserted to perform imaging of the biliary and pancreatic ducts or related operations, such as taking live tissue samples for pathological examination, placing biliary stents, or removing bile duct stones using the duodenoscope.
It is essential to remove bile duct stones as soon as possible, as about 1000ml of bile is secreted into the gut every day to aid digestion, and stones are like dams in a reservoir. Once a blockage occurs in the bile duct, bile cannot flow downward but instead flows backward into the blood, causing symptoms such as abdominal pain, fever, and jaundice. In severe cases, shock and even death may occur. Compared to open surgery, medical ERCP has the advantages of being minimally invasive, less painful, faster to recover from, and offering the possibility of repeated treatment in case of stone recurrence. Therefore, it is the preferred treatment for cholelithiasis.
Biliary tumors can cause narrowing of the bile duct, which can lead to jaundice, dark-colored urine, clay-colored stool, and other severe symptoms. The placement of plastic or metallic stents using ERCP instrument can provide relief by allowing bile to flow smoothly through the narrowed segment of the biliary tract into the intestine, thereby relieving biliary obstruction, reducing jaundice, improving liver function, and preparing for surgical intervention. For patients who cannot undergo surgical treatment or for whom surgery is contraindicated, ERCP can also improve their quality of life and delay disease progression. ERCP placement of stents can also correct strictures caused by benign conditions such as anastomotic strictures after liver transplantation, chronic pancreatitis, and primary sclerosing cholangitis and improve quality of life.
Acute biliary pancreatitis, which accounts for 50% to 60% of cases, is often caused by gallstones, and timely removal of gallstones using ERCP products can help promote pancreatic repair. Pancreatic ductal rupture and pancreatic fistulas can occur with acute and chronic pancreatitis, trauma, or pancreatic surgery. The placement of pancreatic duct stents using ERCP can relieve internal pressure in the pancreas and promote healing of the rupture or fistula. Chronic pancreatitis can lead to pancreatic duct stenosis and pancreatic stones. ERCP drainage and stone extraction can be performed to treat such conditions. Pancreatic pseudocysts, which are a sequela of acute pancreatitis, can be drained using ERCP products, thereby avoiding the need for open surgery.