Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
An ERCP is used to diagnose and treat diseases of the gallbladder, bile ducts, pancreas, and liver.
What Is an Endoscopic Retrograde Cholangiopancreatography (ERCP)?
An ERCP combines endoscopy and X-rays to gain access to bile ducts and the pancreas and create detailed roadmaps that can be used to fix problems in the area.
How Do I Prepare for My Procedure?
Your healthcare professional usually provides written instructions about how to prepare for the ERCP. To begin, your upper GI tract must be empty. Generally, food should be stopped 8 hours prior to the procedure and all liquids should be stopped at least 2 hours prior. Patients should tell their clinician about all health conditions they have, including any heart and lung problems, diabetes, or allergies. A complete list of your medications and supplements will be reviewed. You may be asked to temporarily stop taking medications that affect blood clotting or to otherwise temporarily make adjustments to your medication regimen.
How Is the Procedure Performed?
During the ERCP, the doctor guides an endoscope down the esophagus, through the stomach, and into the duodenum. Video is transmitted to a monitor within the doctor’s view. When the doctor locates the small bile duct opening, a catheter is slid through the endoscope and guided into the ducts, where contrast dye is injected to better view the duct systems.
Based on the condition noted, various procedures may be performed during the ERCP. For example, gallstones might be removed through the ductal opening. Tumors or other tissue might be biopsied. Narrowed passageways or strictures may be dilated with balloon catheters. Stents may be placed and left in place after the ERCP, to allow bile or pancreas juice to drain after a blockage is repaired. An ERCP may be performed after gallbladder surgery if a surgical bile leak is suspected. These delicate surgical procedures performed through a minimally invasive endoscope require the expertise of our therapeutic endoscopists who are trained and experienced in these techniques.
What Can I Expect After My Procedure?
After the ERCP, patients are moved to a recovery room until the sedation wears off. During recovery, some patients may feel bloated or have nausea, which can be treated, as needed. A sore throat may also occur, which can last a day or two. When undergoing an ERCP as an outpatient, you can usually go home after the procedure. Those undergoing complex procedures may need to stay overnight for observation. In all cases, you should follow the instructions and guidance of your doctor as it pertains to your diet, medications, and activities post-procedure.
When Will I Know the Outcome of the ERCP?
Some ERCP results are available immediately after the procedure. Biopsy results are usually ready in a few days. Your doctor will ordinarily try to talk to you when you’re awake enough to recall the conversation, or otherwise will contact you by phone for further discussion, if needed. We will let you know if a follow-up visit in our office is necessary.
How Long Does the ERCP Take?
The ERCP may take anywhere from 30 minutes to 2 hours. After the procedure, you may need to remain in the recovery area for up to a couple hours afterward, or until the sedative wears off.
What Precautions Are Taken to Avoid Infection From the Duodenoscope Used in an ERCP?
The equipment used during an ERCP undergoes strict sterilization to minimize the risk of infection after the procedure. This problem does not exist for routine colonoscopy and upper endoscopy procedures because the scopes used in those procedures don’t have tiny recesses as the duodenoscope does.
What Are the Risks Involved With an ERCP?
Risks associated with ERCP may include:
- Infection, most commonly from bacteria already present in the bile ducts when they are blocked up. Relieving the blockage may help relieve the infection.
- Pancreatitis, a potentially serious inflammation in the pancreas that may be mild but can require a hospital stay to resolve. The most serious but rare complication of an ERCP involves severe pancreatitis, which can be life-threatening. All precautions possible are taken to avoid pancreatitis.
- Adverse reactions to sedatives, usually quite minor or brief
- Excessive bleeding, in the form of vomiting dark/black material, passing black tarry stool, or seeing blood clots in stool.
- Puncture of the GI tract or ducts, a rare but very serious complication of an ERCP
- Death, in rare circumstances
Even when an experienced specialist performs an ERCP, complications can occur in up to 10% of patients. These complications often require hospitalization.
Patients who experience any of the following symptoms after an ERCP should contact their healthcare provider immediately:
- Swallowing difficulties
- Throat, chest, or abdominal pain that worsens
- Bloody or dark stool
What Are My Alternatives to This Procedure?
Radiologists sometimes perform invasive needle catheter procedures to gain access to bile ducts or obtain biopsies of deep tumors. Abdominal surgery to treat gallstones stuck in the duct system was the older method of treatment before ERCP became reliable and most always successful. The surgical procedure requires significant hospital stay and has more potential complications. NOT doing a recommended ERCP can result in death from infection, liver failure, or the deadly progression of tumors, if suspected.