ERCP (Endoscopic Retrograde Cholangiopancreatography) is a procedure where experience is the most important factor in positive outcomes. It requires a special touch, akin to a safe cracker feeling the clicks of a combination lock. Dr Gorcey has been performing ERCP for 32 years. He is a master of the procedure, having performed thousands, with a success rate of over 95% and one of the lowest complication rates in the world. He uses CO2 (carbon dioxide) for all his ERCPs which reduces discomfort after the procedure and allows for faster recovery times.
For evaluation of the Bile duct and pancreatic duct, looking for a source of pain, pancreatitis, abnormal liver enzymes, bile duct stones and cancer. Also used to further evaluate abnormal Cat Scan, Ultrasound or MRI findings.
An endoscope is passed to the opening of the bile and pancreatic duct. A small catheter is then passed into the ducts and contrast dye is injected. The dye shoes up white on the x ray to delineate the anatomy and any abnormalities
If a bile duct stone needs to be removed, a large stent has to be placed, or the opening is too tight to begin with causing pain, a sphincterotomy is performed to widen the opening, allowing a stone or stent to pass, and the pressure in the ductal system to be relieved
Stones of the bile duct can cause pain, jaundice and infection. After a sphincterotomy these stones can be removed by sweeping them out with a balloon or grabbing then with a special basket.
Thin plastic stents which are basically thick walled straws can be placed across benign narrowing or to prevent stones from blocking the opening and causing jaundice. They can allow the sphincterotomy to heal without scarring down as well.
Self expanding metal stents can be used to drain narrowing due to cancer. They can be left in for a longer period of time without getting clogged.
A miniature scope is passed through the main scope directly into the bile duct. Direct visualization of tumors and stones can be attained. Large stones can be broken into smaller stones with the help of this device.