ERCP

ERCP (Endoscopic Retrograde Cholangiopancreatography)

Endoscopic retrograde cholangiopancreatography (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.  ERCP combines the use of x rays and an endoscope, which is al long, flexible, lighted tube.  Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x rays.

For the procedure, you will lie on your left side on an examining table in an x-ray room. You will be given medication to help numb the back of your throat and a sedative to help you relax during the exam. You will swallow the endoscope, and the physician will then guide the scope through your esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x rays. X rays are taken as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

-ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.

Preparation

Your stomach and duodenum must be empty for the procedure to be accurate and safe. You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye. You must also arrange for someone to take you home-you will not be allowed to drive because of the sedatives. The physician may give you other special instructions.  Be sure to inform your doctor of any medical conditions you have or medication you take ona regular basis such as

•  Aspirin
• Arthritis medications
• blood thinners
• diabetes medicaton

What happens after ERCP?

After the test, you will be monitored in the Endoscopy Center for 15-60 minutes until most of the effects of the medication have worn off.  Your throat may be a little sore for awhile, and you may feel bloated right after the procedure because of air introduced into your stomach during the test.

Most patients are allowed t oeat after leaving the Endoscopy Center.

Your phusician will speak to you after the test but you likely will not remember this.  Therefore, the physician will speak with the person driving you home and our nurse will give you written instructions and results of the procedure.

A report will be sent to your primary physician in few days.  Please plan to be at the Endoscopy Center for three hours.

Possible complication of ERCP

Endoscopy is generally safe and complications are rare when the test is performed by a Board-certified gastroenterologist.

Bleeding may if a sphincterotomy of the bile duct is performed t oremove a stone.  Bleeding is usually minimal and rarely requires bloodtranfusions or surgery.

Irritation may occur at the vein where medication were given, sometimes leaving a tender lump lasting severals weeks.  Applying hot moist towels may help relieve discomfort.

Other rare risks include a reaction to the sedatives used, aggravation of heart or lung diseases, or perforation (a tear that might require surgery to repair).

Additional complication of ERCP include pancreatitis (inflammation of hte pancreas), infection, and perforation of the duodenum.  Except for pancreatitis, such problems are uncommon.

Please call the Hepatology Department immediatley if after the procedure you develop fever, pain, or bleeding.