Endoscopic Retrograde Cholangio‐Pancreatography (ERCP)
What is ERCP?
- ERCP is a procedure that enables your doctor to examine the pancreatic and bile ducts. A tube (endoscope) about the thickness of your index finger is placed through your mouth and into your stomach and top part of the small intestine (duodenum).
- In the duodenum a small opening is identified (ampulla) and a small plastic tube (cannula) is passed through the endoscope and into this opening.
- Dye(contrastmaterial) is injected and X-rays are taken to study the ducts of the pancreas and liver. The dye passes harmlessly out after the procedure.
- If necessary to remove stones, a small cut (sphincterotomy) can be made by an electrically heated wire, which you will not feel. The stones can then be removed or broken into pieces to be removed.
- Small tubes(stents) may be inserted to relieve blockages.
Why is an ERCP performed?
ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts ,and is also used to treat those conditions.( stones, narrowing of the ducts)
What preparation is required?
- Your stomach must be empty, so you should not eat or drink anything for approximately 8 hours before the examination.
- Your current medications may need to be adjusted or avoided. Most medications can be continued as usual. Medication use such as aspirin, non-steroidal anti-p, inflammatories, blood thinners and insulin should be discussed with your doctor prior to the examination as well as any other medication you might be taking.
- To make the examination comfortable, you will be
- sedated during the procedure, and, therefore, you will need someone to drive you home afterward.
- Sedatives will affect your judgment and reflexes for the rest of the day, so you should not drive, operate machinery, drink alcohol, sign any legally binding documents until the next day.
What can be expected during the ERCP?
- Your throat will be sprayed with a local anesthetic before the test begins to numb your throat and prevent gagging. You will be given medication intravenously to help you relax during the examination.
- While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your esophagus, and into your stomach and duodenum. The procedure usually lasts about an hour.
- The endoscope does not interfere with your breathing. Most patients fall asleep during the procedure or find it only slightly uncomfortable. You may feel temporarily bloated during and after the procedure due to the air used to inflate the duodenum.
- As X-ray contrast material is injected into the pancreatic or bile ducts, you may feel some minor discomfort.
What complications can occur?
- ERCP is safe but complications can occur.
- Pancreatitis (seen in 5% of cases) due to irritation of the pancreatic duct by the X-ray contrast material or cannula is the most common complication. This can cause abdominal pain and usually requires just a short stay in hospital
- A reaction to the sedatives can occur.
- Bleeding can occur in less than 2% of the cases when a cut is necessary (sphincterotomy) Blood transfusion may be necessary and a stay in hospital at least overnight would be expected.
- In rare cases an operation is required to stop the bleeding.
- Perforation of the oesophagus or duodenum is a very rare complication occurring in less than 1 % of the cases and would mean a stay in hospital and you may require an operation to repair the damage.
- Infection of the bile ducts may rarely occur and is treated with antibiotics
- It is important for you to recognize the early signs of possible complications and to contact your doctor if you notice symptoms of severe abdominal pain, fever, chills, vomiting, or rectal bleeding.
What happens after ERCP
You will be monitored in the endoscopy area until the effects of the sedatives have worn off. Your throat may be a little sore for a day or two. Sometimes, biopsies are taken, results take 1-2 days to return.
Your doctor will discuss the results when you are awake following procedure and decide further plan of management.