GASTRO CENTRS offers high-tech diagnostics and therapy for gastrointestinal, hepatobiliary, and pancreatic pathologies.

ERCP (Endoscopic Retrograde Cholangiopancreatography) is both a diagnostic and therapeutic procedure performed under X-ray guidance using a special duodenoscope. Through the major duodenal papilla, the common bile duct and/or pancreatic duct are cannulated. Contrast dye and various instruments are introduced into the ducts. During ERCP, procedures such as papillotomy, stone removal, stricture dilation, stent placement, or other therapeutic interventions may be performed. ERCP is not performed solely for diagnostic purposes but when a therapeutic intervention is expected during the procedure. If needed, ERCP can be done on the same day as an upper endoscopy or EUS (endoscopic ultrasound). ERCP may also be combined with percutaneous transhepatic bile duct drainage when necessary.

Main indications and clinical situations for the use of ERCP

Bile ducts:

1. Stones in the bile ducts (choledocholithiasis)
2. Cholangitis
3. Bile duct obstruction
4. Postoperative pathological bile leakage
5. Primary sclerosing cholangitis
6. Cholangiocarcinoma
7. Cholestasis of unclear origin

Pancreas:

1. Distal obstruction of the pancreatic duct
2. Stones in the distal part of the common duct
3. Pseudocyst
4. Pancreatic tumor (for bile duct obstruction drainage and biopsy)
5. Postoperative or posttraumatic pathological pancreatic fluid collections
6. Pancreatitis of unclear origin

Diagnostic and therapeutic procedures during ERCP:

• Biopsy
• Cytology smear
• Papillotomy
• Balloon dilation
• Lithotripsy
• Extraction of stones
• Insertion of plastic or metal stent
• Cyst drainage
• Bile duct drainage

Patient referral procedure for ERCP and pre-procedure tests

Important information and documents that the patient must present, in addition to the doctor’s referral, when arriving at the GASTRO CENTER for ERCP:

Results of previous upper endoscopy:

• Copies of the most recent upper endoscopy and histology results and reports
• Copies of previous EUS findings and cytological/histological reports

Results of previously performed radiological imaging diagnostics:

• A current standard (conventional) ultrasonography result and a copy of the conclusion
• For abdominal organ pathology, a current MRI and/or CT result and copies of the conclusions
• Chest CT, if examining esophageal, mediastinal, or lung pathology

Laboratory test results (no older than 3 days before ERCP):

• Complete blood count
• Prothrombin time, INR, aPTT
• Urea, creatinine
• ALT, ALP, GGT, Bilirubin
• Amylase, Lipase
• C-reactive protein (CRP)

Cardiovascular and pulmonary test results:

• ECG, if there is a known cardiovascular pathology or for everyone > 50 years old.
• Pulmonary function tests, if there is a known significant lung pathology.

Use of antiplatelet and antithrombotic agents

The use of antiplatelet and antithrombotic agents must be discontinued before high-risk invasive procedures and surgeries according to the recommendations for each medication. After EUS, the medications should be resumed the following day.

ERCP procedure at GASTRO CENTRS

The patient should be prepared as for an upper endoscopy and anesthesia. The patient and companion must arrive at least 30 minutes before the scheduled procedure time. ERCP is always performed under anesthesia. Usually, intravenous anesthesia with propofol or other medications is used, but in some cases, general endotracheal anesthesia is required.

If a biopsy or cytology is performed during ERCP, then the tissue material is sent by GASTRO CENTRS to the appropriate laboratory for examination. Results from the laboratory are usually available within 5–10 days.

Immediately before, during, or after ERCP, intravenous administration of antibacterial agents may be necessary. All available information about previously used antibacterial therapy, antibiotic resistance, or allergies must be indicated in the referral for ERCP.

The procedure lasts 1–2 hours. The post-procedure observation period in the day hospital is 2–4 hours. The total time at GASTRO CENTRS is 6 hours. If a longer observation period is needed after the procedure, the total time may be longer. If necessary, the patient may require emergency hospitalization after EUS.

The ERCP report and X-ray images with the radiologist’s conclusion are prepared by the doctor within 3 working days. If a biopsy or cytology has been performed, the final report is completed within 2 weeks. The ERCP protocol, X-ray images, and the corresponding tissue examination reports are available on the DATAMED website once they are prepared.

Referral procedure for ERCP at GASTRO CENTRS

ERCP is scheduled by calling the GASTRO CENTRS client center at 66901212 or by sending the referral form via email, which is available at www.gastrocentrs.lv.

Referral sample for ERCP at GASTRO CENTRS:

• Patient’s first name, last name, gender, age, personal identification number
• Expected medical status of the patient at the referring institution on the day before the procedure: outpatient / day hospital / inpatient / ICU
• Referring doctor’s first name, last name, specialty, institution, contact phone number
• Referral diagnosis
• Secondary diagnoses
• Significant procedure risks or other important additional information
• Results of previously performed radiological and/or endoscopic examinations justifying the diagnosis and the need to perform ERCP: US, CT, MRI, ERCP, upper endoscopy, other
• Total bile duct diameter above the papilla or stricture, stricture location
• Significant changes in laboratory tests: none / present
• Planned ERCP procedure timing: urgent / as soon as possible / scheduled
• Planned medical status of the patient at the referring institution after ERCP – outpatient / day hospital / inpatient / ICU