Endoscopic procedures for liver diagnosis

Endoscopic procedures are an established and reliable method of investigating the body’s internal organs. An endoscope is a long, flexible fibre optic tube with a tiny camera and a light on the end.

ERCP is an endoscopic procedure that is valuable in both examining your biliary and pancreatic structures. It can identify problems with the biliary tree, cystic duct obstruction, gallstones, narrowings and tumours. As a treatment, ERCP can use interventions to drain pus as well as dislodge, break down and remove gallstones.

You should get instructions from the hospital where your ERCP has been scheduled. These will provide you with guidelines on any preparations you need to make before the procedure, such as how long beforehand you’ll need
to stop eating and drinking, and whether it means any possible changes in your medication.

At the beginning of the procedure, the doctor will spray the back of your throat with a local anaesthetic to make it feel numb. Sometimes a local anaesthetic lozenge is used, or you will be given a sedative injection through the drip
(venflon) in your hand or arm. This will make you drowsy so that it lessens the discomfort of having a tube passed into your gullet. You will be positioned on your side to follow the curvature of your gut.

The doctor will ask you to swallow the first section of the endoscope. After this the doctor will push it further down your gullet into your stomach and duodenum. The doctor will look at images on a TV monitor which come from
the endoscope’s camera which is filming the procedure.

Air is also passed into the tube into your gut to make it easier to see the lining of the gut. This may make you feel bloated.  The endoscope is designed with an attachment down which small instruments and tubes can be passed.

Endoscopic procedures

A small tissue sample (biopsy) from the lining of the gut can be taken to check for abnormal tissue or cells. The sample is used for two types of test, histology and pathology (see page 22).

If the X-rays show a gallstone obstructing the bile duct, the doctor can widen the duct by making a cut to let the stone into the duodenum. This is called a sphincterotomy.

If there is a narrowing in the bile duct the doctor can place a stent to open it up and keep it from collapsing. The stent can remain in place to help to drain away bile into the duodenum.

The endoscope is gently pulled out when the procedure is completed. It takes around 30 minutes to one hour, depending on what is done.

Your aftercare will depend on the findings of the ERCP. You might be booked in for an overnight stay if you have received a stent or had gallstones removed. You should not drive for 24 hours after receiving a sedative.

Ask a friend or relative to drive you home from hospital. Also make sure that someone can stay with you for the first 24 hours after discharge from hospital.  The hospital will also provide you with information when you are discharged
that will help with any problems that might arise after an ERCP procedure.

Endoscopic techniques are also used to treat bleeding varices (small, protruding veins in the stomach and gullet). The most common technique is variceal banding (see below). Occasionally injection scelotherapy may be
performed, which is when a saline solution is injected into a vein, causing the walls of the injected vein to collapse and seal shut. Blood is directed through other, unaffected veins, and eventually the collapsed vein is reabsorbed into
the body.