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What is an ERCP?

Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized technique used to study the ducts of the gallbladder, pancreas, and liver. Ducts are drainage routes; the drainage channels from the liver are called bile or biliary ducts. During ERCP, your doctor will pass an endoscope through your mouth, esophagus, and stomach into the duodenum (first part of the small intestine). An endoscope is a thin, flexible tube that lets your doctor see inside your bowels. After your doctor sees the common opening to ducts from the liver and pancreas, your doctor will pass a narrow plastic tube called a catheter through the endoscope and into the ducts. Your doctor will inject a contrast material (dye) into the pancreatic or biliary ducts and will take X-rays.

Your Preparation

  • To allow a clear view, you should not eat or drink anything after midnight.
  • Do not take aspirin, iron tablets or any blood thinning medications at least 5 days prior to the procedure.
  • Do not take insulin or anti diabetes medications the morning of your ERCP. Let your doctor know about it.
  • If you take a blood thinner called Coumadin let your doctor know.
  • Bring your medications with you on the day of the procedure so that you can take them after the procedure.
  • Let the doctor know if you could be pregnant. This procedure could be unsafe for pregnant women.
  • If you have Prosthesis, Artificial heart valves, heart murmur, arterial graft or have required prophylactic antibiotics in the past, please let the doctor know in advance.

What will happen during the examination?

The doctor and nurse will explain the procedure and answer your questions. Please tell them if you have had any other endoscopy examinations. Please tell the doctor and the nurse if you have had any allergies or bad reactions to medications or contrast dye.

You will be asked to sign a consent form giving permission for the procedure. You will be required to put on a hospital gown, and remove eyeglasses, contact lenses and/or dentures.

The examination will be performed on an X-ray table. Local anesthetic will be sprayed into your throat to make it numb, and you will be given medication through an IV to make you sleepy and relaxed. With you in a comfortable position on your stomach, the doctor will pass the end oscope down your throat. A guard will be in place to protect your teeth. The endoscope will not interfere with your breathing and will not cause any pain. You may be asked to change your position during the examination, but the nurse will help you do this. The examination takes from 1 to 3 hours. Many people do not recall any of the procedure because of the effect of the medicine.

What treatments may be used during ERCP?

Sphincterotomy: If the X-rays show a gallstone, or other blockage, the doctor can enlarge the opening of the bile duct. This is called “Sphincterotomy”, and is dome with an electrically heated wire, which you will not fell. Any stones will be collected in a tiny basket, or extracted with a balloon.

Stenting: A stent is a small plastic tube which is pushed through the endoscope and into a narrowed area in the bile duct. This relieves the jaundice, by allowing the bile to drain freely into the intestine, Sterns are also placed in the pancreatic duct when it is narrow or blocked.

Naso-billiary tube: Sometimes a small plastic tube is left in the bile duct, and brought out through the nose for a few days. This helps the drainage of bile, and allows X-rays to check when the bile duct is clear. The tube may be slightly uncomfortable at first, but does not interfere with eating or drinking.

What will happen after the procedure?

Your throat may feel numb and slightly sore. Because of the local anesthetic and sedation you should not attempt to take anything by mouth for at least 1 hour. It is wise to keep to clear liquids fort the remainder of the day. If you are an outpatient, you will remain in the facility for at least one hour. Someone must be able to drive you home because of the sedation impairs the reflexes and judgments. For the remainder of the day you should not drive a car, operate machinery, or make any important decisions. We suggest that you rest quietly.

With this type of procedure there is a possibility of an overnight stay in the hospital. Please come prepared in the event an overnight stay is required.

What are possible complications of an ERCP?

ERCP is a well-tolerated procedure when performed by doctors who are specially trained and experienced in the technique. Although complications requiring hospitalization can occur, they are uncommon. Complications can include pancreatitis (an inflammation or infection of the pancreas), infections, bowel perforation, and bleeding. Some patients can have an adverse reaction to the sedative used. Sometimes the procedure cannot be completed for technical reasons.

Risks vary, depending on why the test was performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether the patient has major medical problems. Patients undergoing therapeutic ERCP, such as for stone removal, face a higher risk of complications than patients undergoing diagnostic ERCP. Your doctor will discuss your likelihood of complications before you undergo the test.

Please contact your doctor promptly if you have any follow-up questions or if you are experiencing any complications due to the procedure.

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ERCP Checklist Download
ERCP Infosheet Download