ERCP: Much ado about blockages
Michele Pliego Bruesehoff BAN, RN, CGRN

September 2010 
Volume 40  Number 9
Pages 46 - 50
  PDF Version Available!

JEFF TIERNEY, 71, ARRIVES on your unit with a 2-week history of epigastric pain, fever, vomiting, and jaundice. Liver panel results are elevated: total bilirubin, 3.1 mg/dL (normal: 0.3 to 1.0 mg/dL), alkaline phosphate, 792 IU/L (normal: 46–108 IU/L), AST 140 IU/L (normal: 5–34 IU/L), and ALT 119 IU/L (0–55 IU/L). A right upper quadrant ultrasound reveals common bile duct (CBD) dilatation. Mr. Tierney is scheduled for emergency endoscopic retrograde cholangiopancreatography (ERCP).When you walk into his room before the procedure, you find Mr. Tierney and his wife with puzzled looks on their faces. They ask you to explain what to expect.Over 500,000 ERCPs are performed annually in the United States.1 It's highly likely that if you haven't already, you'll soon find yourself in a situation like the one described above. This article will provide you with the background you need to answer your patient's questions about ERCP and provide care before and after the procedure.By combining endoscopy and fluoroscopy, ERCP can reveal stones, tumors, or strictures in the ducts that drain the liver, gallbladder, and pancreas. (See Reviewing biliary system anatomy.) During an ERCP, the pancreatic ducts (PDs) and CBD are injected with a contrast medium to make them visible by radiologic imaging. If only imaging is performed, the procedure is called diagnostic ERCP. If a stenosis or obstruction is found and treated, or if tissue sampling is performed, it's called therapeutic ERCP. Most ERCPs performed today are therapeutic. Diagnostic ERCPs are rarely needed anymore because of advances in less invasive imaging techniques such as magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), and computed tomography (CT).Common indications for an ERCP include: * choledocholithiasis (CBD stones), the most common cause of biliary obstruction2 * evaluation of chronic pancreatitis * evaluation for cancer of bile ducts or pancreas * jaundice

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