endoscopic retrograde cholangio pancreatogram


An endoscopic retrograde cholangio pancreatogram (ERCP) is a test that combines the use of a flexible, lighted scope (endoscope) with X-ray pictures to examine the tubes that drain the liver, gallbladder and pancreas.The endoscope is inserted through the mouth and gently moved down the throat into the esophagus, stomach, and duodenum until it reaches the point where the ducts from the pancreas (pancreatic ducts) and gallbladder (bile ducts) drain into the duodenum.

ERCP is done to

  • Check persistent abdominal pain or jaundice
  • Find gallstones or diseases of the liver, bile ducts, or pancreas
  • Open a narrowed bile duct or insert a drain
  • Get a tissue sample for further testing (biopsy)
  • Measure the pressure inside the bile ducts (manometry)


Gastroscopy is an examination of the inside of the gullet, stomach and duodenum. It is performed by using a thin, flexible fibre-optic instrument that is passed through the mouth and allows the doctor to see whether there is any damage to the lining of the oesophagus (gullet) or stomach, and whether there are any ulcers in the stomach or duodenum. The procedure is painless and is usually done under a light sedative as a day-case patient in a specialised endoscopy unit.

A gastroscopy may be advised if you have symptoms such as

  • Recurring indigestion
  • Recurring heartburn
  • Pains in the upper abdomen
  • Repeated vomiting
  • Difficulty swallowing

Percutaneous Endoscopic Gastrostomy

A percutaneous endoscopic gastrostomy (PEG) is a procedure for placing a feeding tube directly into the stomach through a small incision in the abdominal wall with the assistance of an instrument known as an endoscope. The procedure is performed as a means of providing nutrition to patients who cannot take food by mouth. Many stroke patients, for example, have poor control over their swallowing muscles and are unable to safely consume enough food, or they have muscle weakness that allows food to leak into the lungs when they swallow things by mouth.

Benefits of PEG Feeding are

  • Nutritional status is improved
  • Low incidence of complications
  • Reduction in aspiration pneumonia associated with swallowing disorders
  • Satisfactory use by home carers


Colonoscopy is a procedure that enables an examiner (usually a gastroenterologist) to evaluate the inside of the colon (large intestine or large bowel). The colonoscope is a four foot long, flexible tube about the thickness of a finger with a camera and a source of light at its tip. The tip of the colonoscope is inserted into the anus and then is advanced slowly, under visual control, into the rectum and through the colon usually as far as the cecum, which is the first part of the colon.
Colonoscopy is also a safe and effective way to evaluate problems such as
  • Blood loss
  • Abdominal or rectal pain
  • Changes in bowel habits, such as chronic diarrhea
  • Active bleeding from the large bowel


Brig. (Retd) Dr. Iqbal

Gastroenterologist and Hepatologist

With over 25 years of healthcare industry experience, Dr. Iqbal serves as the Head of Gastroenterology Department at Quaid e Azam International Hospital Near Golra Morr, Adjacent Froebels School, Peshawar Road, Islamab.

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Esophagogastroduodenoscopy (EGD) with biopsy, is also known as upper endoscopy. This test involves passing an endoscope, a long, flexible black tube with a light and video camera on one end, through the mouth to examine the esophagus, stomach and the first part of the small intestine called the duodenum. The advantages of this test over the barium esophagram (x-ray test) are that the lining of the upper digestive tract can be directly viewed by the doctor and very small abnormalities seen. Endoscopic therapies (treatments) can be performed at the time of the procedure

Abnormalities that may be detected include:

  • Ulcers—breakdowns in the lining of the organs
  • Esophagitis—inflammation of the esophagus
  • Gastritis—inflammation of the stomach
  • Infections
  • Tumors or cancer

Variceal Banding

Varices are dilated blood vessels in the esophagus or stomach caused by portal hypertension. They cause no symptoms unless they rupture and bleed, which can be life-threatening.Someone with symptoms of bleeding varices should seek treatment immediately. Doctors can stop the bleeding and help prevent varices from coming back. Bleeding from varices is a medical emergency. If the bleeding is not controlled quickly, a person may go into shock or die. Variceal Banding is a procedure in which a gastroenterologist places small rubber bands directly over the varices. This will stop the bleeding and get rid of the varices.

Symptoms of bleeding varices are

  • Vomiting of blood
  • Black, tarry, or bloody stool
  • Low blood pressure
  • Rapid heart rate
  • Lightheadedness

Polyps Removal


A colon polyp is a small clump of cells that forms on the lining of the colon. Most colon polyps are harmless. But over time, some colon polyps can develop into colon cancer, which is often fatal when found in its later stages. Anyone can develop colon polyps. You’re at higher risk if you’re 50 or older, are overweight or a smoker, or have a personal or family history of colon polyps or colon cancer. Colon polyps often cause no symptoms. You might not know you have a polyp until your doctor finds it during an examination of your bowel.

But some people with colon polyps experience:

  • Rectal bleeding
  • Change in stool color
  • Change in bowel habits
  • RPain, nausea or vomiting
  • Iron deficiency anemia