Endoscopy or ERCP

Patient

Q: I saw a surgeon yesterday and they told me that they found something on or in my liver from a previous ultrasound, and that they are now going to go in with an endoscopy to get a better look. They didn't say, but hinted at something possibly serious so I am wondering what a doctor would typically be looking for with this particular procedure.

Doctor

A:   A simple endoscopy procedure involves passing a scope down through the oesophagus (food pipe), the stomach, to the first part of the duodenum (small intestine). The scope is basically a tube with a camera and light source on one end. The camera records a continuous picture of the anatomy and walls of the oesophagus, stomach, and duodenum, and allows the gastroenterologist to view this live picture on a monitor. If there are any areas of inflammation or abnormality, a small tissue sample (biopsy) can be obtained and sent to the laboratory, where it can be analyzed under the microscope. The procedure usually lasts approximately 30 – 40 minutes and does not require a general anaesthetic. However some sedation will be given prior to the procedure, which is usually performed as a day procedure, and therefore you will be unable to drive after the procedure.
An endoscopy does not visualize the liver or surrounding structures such as bile ducts or the pancreas. You may also be referring to an ERCP (endoscopic retrograde cholangiopancreatography) procedure. This involves the use of a scope, but in addition to the visualization of the oesophagus, stomach and small intestine, an x-ray image is taken simultaneously, which allows imaging of the bile ducts and pancreas. This procedure is more invasive than a simple endoscopy and there is a significant risk of pancreatitis post-ERCP. I would advise discussing the risks and benefits of this procedure with your surgeon.

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