Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to treat problems of the bile ducts and pancreatic ducts. The endoscopic portion of the examination uses a side-viewing duodenoscope that is passed through the esophagus and stomach and into the second portion of the duodenum.

Why Do Doctors Use ERCP?

Doctors use ERCP mainly to treat problems present in the bile and pancreatic ducts. ERCP is also used as a diagnostic tool to detect problems with the bile and pancreatic ducts, prior to a surgical procedure.
For diagnosis alone, doctors usually perform noninvasive tests. Such noninvasive tests include magnetic resonance cholangiopancreatography (MRCP); a type of magnetic resonance imaging (MRI) which is safe and can also diagnose many problems of the bile and pancreatic ducts.
ERCP is necessary in cases where the bile or pancreatic ducts are narrowed or blocked due to:

  • Gallstones that form in your gallbladder and get stuck in the common bile duct
  • Infection
  • Acute pancreatitis
  • Chronic pancreatitis
  • Trauma or surgical complications in your bile or pancreatic ducts
  • Pancreatic pseudocysts
  • Tumours or cancers of the bile ducts
  • Tumours or cancers of the pancreas

How Do Patient Prepare for ERCP?

Patients need to set up a consultation with their doctor to discuss the procedure before it is performed. It is best for patients to arrange for a ride home after the procedure, as it is not advisable to drive immediately. It is also mandatory to follow the doctor’s post procedure care instructions well.

Consult with your doctor

Any allergies and medical conditions should be discussed with the doctor in charge prior to the procedure. You should also inform your doctor about all prescribed and over-the-counter treatments, vitamins, and supplements that you are currently taking, including:

  • Arthritis medicines
  • Blood thinners
  • Blood pressure medicines
  • Diabetes medicines
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen

This is important as it alerts doctors of any medication they need to stop that may affect the procedure, for example, medication that can affect blood clotting or interfere with sedatives. Sedatives are usually administered during ERCP to help patient relax and cope with the discomfort.

Plans for a ride home

For safety reasons, patient are not allowed to drive for 24 hours after ERCP, as the sedatives or anesthesia used during the procedure needs time to wear off. It is best to arrange for transportation home after ERCP.

No food or drinks

In order to get clear visualization of the upper GI tract, the doctor will most likely ask patients not to eat, drink, or smoke for 4 to 6 hours leading to ERCP.

How ERCP is Perform?

Prior to the procedure, sedatives will be administered via intravenous (IV) needle in the patient’s arm. Sedatives help to ensure patient stay relaxed and comfortable during the procedure. Then, liquid anesthetic or spray anesthetic will be administered to the back of your throat. The anesthetic works to numb the throat and helps prevent gagging during the procedure. In some cases, patient may also receive general anesthesia.

You will usually need to lie on your stomach (prone position), then the doctor will carefully feed the endoscope down the esophagus, through your stomach, and into your duodenum. A small camera mounted on the endoscope will send a video image to a monitor. The endoscope pumps air into your stomach and duodenum to make them clearly visible.

During ERCP, the doctor

  • Ocates the opening where the bile and pancreatic ducts empty into the duodenum
  • Slides a thin, flexible tube called a catheter through the endoscope and into the ducts
  • Injects a special dye called contrast medium into the ducts through the catheter, to make the ducts more visible on x-rays
  • Uses a type of x-ray imaging called fluoroscopy, to examine the ducts and look for narrowed areas or blockages

The doctor may pass a small tool through the endoscope to:

  • Open blocked or narrowed ducts.
  • Break up or remove stones.
  • Perform a biopsy or remove tumors in the ducts.
  • Insert stents (tiny tubes that a doctor leaves in narrowed ducts to hold them open)
  • Doctor may also insert temporary stents to stop bile leaks that can occur after gallbladder surgery.

Normally, the whole procedure takes about 1 hour.

What should I expect after ERCP?

After ERCP, you can expect the following:

  • You will usually have to stay in the hospital or outpatient center for 1 to 2 hours after the procedure so the sedation or anesthesia can wear off. In some cases, you may need to stay overnight.
  • You may have bloating or nausea for a short time.
  • You may have a sore throat for a day or two.
  • You can go back to a normal diet once your swallowing has returned to normal.
  • You should rest at home for the remainder of the day.

Results from ERCP are available immediately after the procedure. After the sedative wears off, the doctor will discuss the results with you, or if you prefer, with a friend or family member.

If the doctor performed a biopsy, a pathologist will examine the biopsy tissue. Biopsy results take a few days or longer to come back.

What are the risks of ERCP?

The risks of ERCP include the following:

  • Pancreatitis
  • Infection of the bile ducts or gallbladder
  • Bleeding
  • An abnormal reaction to the sedative, including respiratory or cardiac problems
  • Perforation in the bile or pancreatic ducts, or in the duodenum near the opening where the bile and pancreatic ducts empty into

Complications after ERCP

Although it is rare to experience severe complications after ERCP, sometimes patient may suffer side effects. If you have any of the following symptoms after ERCP, seek medical attention immediately:

  • Problems swallowing or throat pain that gets worse
  • Vomiting (vomit color looks like coffee grounds)
  • Pain in your abdomen that gets worse
  • Bloody or black coloured stool
  • Difficulties in breathing
  • Chest pain
  • Fever

ERCP is advanced endoscopy, and a minimally invasive tool to treat specific conditions especially stone disease. It can help avoid major surgery in many instances. Do contact us if you have been recently diagnosed with bile duct stones, bile duct cancer or pancreatic cancer.