ERCP stands for endoscopic retrograde cholangiopancreatograph. ERCP is a procedure used to study the ducts (drainage tubes) from the liver, gallbladder, and pancreas. The liver is the largest organ in the body, and along with many other functions, it produces bile which aids in digestion. Some bile is stored in the gallbladder. The bile ducts carry bile from the liver and gallbladder to the first part of the intestine (the duodenum). There it meets food from the stomach. The pancreas lies behind the stomach and also makes digestive juices. The pancreatic duct and the bile duct meet as they enter the duodenum. An endoscope (thin flexible tube which allows the physician to see inside the bowel) is passed through the mouth, esophagus, and stomach and into the duodenum. A small plastic tube or catheter is passed through the endoscope and into the ducts. Contrast material (“dye”) is then injected into the ducts and X-rays are taken. Physicians with special training can accomplish ERCP in about 95% of cases.
- 01. Reasons for the Exam
- 02. Equipment
- 03. Benefits
- 04. Side Effects and Risks
- 05. Alternative Testing
- 06. Preparation
- 07. Before the Procedure
- 08. The Procedure
- 09. After the Procedure
- 10. Results
01. Reasons for the Exam
ERCP can be helpful in diagnosing or treating a number of conditions such as:
- Gallstones which are trapped in the main (common) bile duct.
- Blockage of the bile duct.
- Yellow jaundice (the skin becomes yellow).
- Pancreatitis (inflammation of the pancreas).
- Cancer of the bile ducts of pancreas.
- Abdominal pain of several causes.
The endoscope is a thin flexible lighted tube which is passed through the mouth into the upper small intestine. It contains an optically sensitive computer chip in the tip which transmits the signal onto a video screen. Dials permit the physician to steer the instrument in every direction. Other instruments can be passed through the endoscope to remove stones, relieve obstructions, and perform other tasks. The procedure is performed with the patient under an X-ray camera so that the bile ducts and pancreas can be continuously observed.
ERCP is the least invasive and most specific way of evaluating the bile ducts and pancreatic ducts. It can be performed safely and with minimal discomfort to you. In addition to providing a diagnosis, in many cases it allows the physician to perform specific treatment. Frequently a sphincterotomy (papillotomy) is performed. This procedure uses a thin wire with electrical cautery to enlarge the opening of the bile duct. Stones can be removed or a drainage tube (stent) can be placed to relieve an obstruction.
04. Side Effects and Risks
No test is 100% accurate and infrequently ERCP can miss abnormalities which are present. In addition, sometimes for anatomical reasons, it is not possible to inject the contrast material into the ducts. A mild sore throat occasionally follows the procedure. You may have a feeling of bloating which is also temporary. Complications are uncommon. Oversedation occurs infrequently and almost always can be reversed. A localized irritation of the vein can occur at the IV site, resulting in a tender lump which may last for several weeks. Application of hot moist towels may relieve the discomfort. Pancreatitis (inflammation of the pancreas) occurs in about 2-5% of cases (5-10% if sphincterotomy is required). In most cases, the pancreatitis is mild but severe cases can occur. Other potential complications include bleeding (rarely requiring transfusion or surgery), perforation (a tear in one of the organs), infection of the bile or pancreas, worsening of underlying heart or lung disease, and adverse reaction to one of the sedatives. Any of these complications could involve hospitalization, emergency surgery, or in an exceptionally rare case of death.
05. Alternative Testing
One alternative to ERCP would be exploratory surgery. Another alternative is percutaneous transhepatic cholangiography involves passing a needle through the skin and the liver into the bile ducts under X-ray guidance. This procedure is more painful, has a slightly greater risk of complications, and does not offer visualization of the pancreas.
For the physician to have a clear view, the stomach must be empty. It is very important that you have nothing to eat or drink after midnight the evening before the procedure. If your procedure is scheduled in the afternoon, you may be instructed to have an early clear liquid breakfast. An exception to this is prescription medication. You can take these on the morning or afternoon of the exam with a few sips of water. It is especially important to take any high blood pressure or heart medication.
If you take any of the following medications, notify our office prior to the procedure because they may need to be stopped or the dosage may need to be adjusted.
- Coumadin (Warfarin)
- Insulin or other medication for diabetes.
07. Before the Procedure
You will be asked to arrive well ahead of the scheduled procedure time. Please bring your insurance cards with you. It is advised that you leave your valuables at home or with whomever accompanies you. YOU MUST HAVE SOMEONE DRIVE YOU HOME OR THE PROCEDURE WILL NOT BE PERFORMED.A brief medical history will be reviewed with you by a nurse. Please bring a list of your current medications, and any allergies to medications. You will be asked to remove your clothing and change into a patient gown.
08. The Procedure
An intravenous (IV) catheter will be placed into your arm so that medications can be given for sedation. It is generally not a painful exam, but the sedation helps you to relax. Most of the effects of the sedation persist for 15-60 minutes, and you may not be able to recall the procedure afterwards. Your throat is usually anesthetized with a spray or liquid to minimize the gag reflex. The endoscope is then gently inserted into the upper esophagus and advanced through the upper airway and does not interfere with normal breathing. You will be monitored closely throughout the exam. As the exam takes place, any additional necessary procedures are performed. For example, a biopsy can be performed where a small piece of tissue is removed for microscopic analysis.
09. After the Procedure
You will remain in the recovery area for one hour or more after the procedure depending on your vital signs and level of consciousness. You may feel bloated from the air used during the exam.The medication given to you during the examination may affect your reflexes and judgment. Therefore, you should not drive a car, operate machinery, or make any legally binding decision for the remainder of the day.
Following the exam, your physician will discuss the results with you and your family. If you want family members to hear the results of your test, they should remain in the waiting area for the duration of your stay. The average wait will be about 3 hours.