What is ercp ? what are the causes of biliary tract obstruction?
Definition of ERCP
Ercp is a word formed from the initials of Endoscopic Retrograde Cholangio Pancreotography. The image of the bile ducts is obtained endoscopically by going up to the area where the bile ducts flow through and by placing a catheter at the exit of the bile duct and giving a liquid contrast material that can be seen in x-ray. Thus, it is understood whether there is a stone in the bile ducts or a pressure from any tumor.
While ERCP was performed only for the purpose of diagnosing the pathologies in the biliary tract in the previous years, nowadays it has received MRCP or endoscopic ultrasound examinations for this purpose. Ercp is now made for therapeutic purposes only. The place where ERCP is mostly used is the obstructive jaundice problems caused by the stones in the bile ducts. Stones in the bile ducts usually form by falling from the gallbladder on this path. However, new stones may also form from the bile ducts itself over time, especially in people whose gall bladder has been removed before. When stones fall into the bile ducts, the stone moves towards the exit of the bile ducts. And he wants to pass from here to the small intestine. Normally, when the bile ducts approach the small intestine where it flows, it joins with the main channel coming from the pancreatic gland. They drain into the small intestine as if two rivers flow out of a single mouth. Therefore, when a stone falling into the bile ducts comes to the exit and does not pass the narrow exit here, it blocks both the bile ducts and the pancreatic duct.
Bile duct anatomy
The place where the bile ducts open to the small intestine is called papillae. When the papilla is viewed from the small intestine, it looks like a nipple. A very small and indistinct canal mouth can be chosen in the middle. There is a space called the ampulla vater where the bile ducts and the pancreatic duct join together when only a small amount is passed through this channel. Stones can sit in this area and block both channels.
The papilla is where the bile duct and pancreatic duct unite and flow into the small intestine as a single mouth.
The name of the common bile duct is the common bile duct or can be called the main bile duct. When the common bile duct is blocked by a stone, the substance called bilirubin in the bile cannot pass into the small bile ducts in the liver, since it cannot drain the bile fluid that must reach the small intestine through it. These substances, which cannot be thrown into the bile ducts, begin to pass into the blood. An increase in Bilirubin level in the blood will cause yellowing in the whole body, especially in the skin and eyes. This is called obstructive jaundice. Here, ERCP provides cutting and expanding the lower end with a device called papillotoma in the bile ducts, especially in obstructive cases such as stones, as well as removing these foreign substances from the bile duct with balloon or basket-shaped catheters.
WHAT ARE THE MAIN REASONS THAT MAKE CLOSING YELLOW?
Gallstones falling into or forming in the common bile duct Bulb vater tumors Pancreatic head tumors Chronic pancreatitis Bile duct tumors Accidental connection of the common bile duct during gallbladder removal operations Mirizzi syndrome -> occurs as a result of acute gall bladder inflammation pressing on the bile ducts.
WHAT TREATMENTS ARE AVAILABLE WITH ERCP?
With ERCP, stones that cause obstruction in the biliary tract can be removed. The common bile duct outlet opening can be opened by cutting the ampulla vater adenomas that may cause obstruction. In pancreatic head tumors that may cause obstruction, temporary nasobil space drainage catheters can be inserted to reduce the risk of surgery by reducing the elevated bilirubin values while preparing the patient for surgery. Permanent stents can be inserted to provide bile flow in advanced pancreatic head tumors that can cause obstruction and are inoperable.