Patient Education:   Endoscopic Retrograde Cholangiopancreatography (ERCP)

An ERCP (endoscopic retrograde cholangiopancreatography) is a procedure used to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It is performed using an endoscope, which is a long, flexible tube with a light and camera on the end. The endoscope is inserted through the mouth, down the throat, and into the small intestine.

During the procedure, the doctor will inject a dye into the bile ducts and pancreas to make them visible on an x-ray. This allows the doctor to see any abnormalities or blockages in these organs. The doctor may also use special tools through the endoscope to take a biopsy (a small sample of tissue) or to remove a blockage.

The procedure usually takes about an hour to complete and is usually done under sedation, so you will be awake but relaxed and comfortable.

Your doctor may suggest patients get an ERCP to find the cause of unexplained abdominal pain or yellowing of the skin and eyes (jaundice). It may be used to get more information if you have pancreatitis or cancer of the liver, pancreas, or bile ducts. Other things that may be found with an ERCP include blockages or stones in the bile ducts.

Prior to the endoscopy, you will be asked questions regarding your medical history and the medications you are currently taking, and the results of your blood tests (if any were ordered). You will then receive sedation through an intravenous (IV) line. In some cases, anti-inflammatory medication is given as a rectal suppository – this is to lower any risk of acute inflammation of the pancreas (pancreatitis) following the procedure)

You will be asked to lie on a special table and will be appropriately positioned for the procedure. A plastic mouth guard may be placed between the teeth to prevent damage to the teeth and endoscope.

The ERCP endoscope is a special flexible tube that contains a lens and a light source so the endoscopist can view the inside of your body. Once the scope is gently inserted through the mouth, it is then passed into the esophagus, stomach, and intestine. Then, a small plastic tube (cannula) is passed through the endoscope into the opening of the bile duct through the papilla. A guidewire may be inserted into the bile duct before dye is injected. X-ray pictures are taken after the dye injection and displayed on a monitor so the endoscopist can examine the bile ducts and pancreatic duct.

Depending on what the endoscopist sees during the ERCP, they may perform a variety of procedures or treatments. If bile duct stones are present in the common bile duct, the opening of the papilla can be widened with electrocautery (which uses an electrical current to cut into tissue), and the stones are removed. If the X-ray pictures show a narrowing of the bile duct, a stent (a small wire-mesh or plastic tube) can be inserted to allow the bile to bypass the blockage and pass into the duodenum.

The length of the exam varies between 30 to 90 minutes.

You will be instructed not to eat or drink for a certain amount of time before the examination (typically 6-8 hours). It is important for the stomach to be empty to allow the endoscopist to visualize the entire area, and to decrease the chance of vomiting during the procedure.

You may be instructed to adjust the dose of your medications or stop taking specific medications prior to the examination. ALL medications and dietary supplements should be discussed with your provider.

You will need a friend or family member to bring you home after the examination as the medications used for sedation can impair reflexes, judgment, and your ability to drive (similar to the effects of alcohol).

ERCP is a generally safe procedure and serious complications are uncommon. If complications do occur, they are usually mild although can be moderate or severe, and may include the following:

• Pancreatitis (inflammation of the pancreas) – most frequent complication, occurring in 3-5% of people undergoing ERCP
• Bleeding
• Perforation
• Infection of the bile ducts (cholangitis)
• Aspiration of food or fluids into the lungs

If you have any of the following symptoms, let your health care provider know immediately or seek emergent care at your local hospital or urgent care:

• Severe abdominal pain (not just gas cramps)
• A firm, distended abdomen
• Vomiting
• Fever or chills
• Black or bloody stools
• Difficulty in swallowing or a severe sore throat
• A crunching feeling under the skin

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