Endoscopic Retrograde Cholangiopancreatography

What is ERCP?

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic and very useful therapeutic tool to evaluate the ducts and anatomy of the biliary system and pancreas. This involves the passage of a specially designed upper endoscope that can be guided to the opening of the biliary and pancreatic ducts in the duodenum, and the usage of a variety of accessories and device that can access these ductal systems. A few indications of this procedure include impacted gallstones, pancreatic or biliary malignancy (both to diagnose and treat), abnormalities of the pancreatic duct from prior injury, and abnormalities of the bile duct resulting in jaundice.<

The procedure is more involved than traditional upper endoscopy, and lasts longer, typically 30 to 60 minutes.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

The above pictures are from an ERCP performed by an Associates in Gastroenterology physician for a patient with a bile duct obstructed by a gallstone. The picture on the left shows the bulging major papilla. Next, a catheter is guided into the bile duct, and a sphincterotomy is made to enlarge the opening of the bile duct. The final picture shows the gallstone falling out of the bile duct after the sphincterotomy.

What preparation is required for an ERCP?

We ask that you not eat or drink for 6 hours before your procedure.

In addition, we ask that you stop these medications:

Please check with the doctor who prescribed them before stopping them!

7 days prior to your procedure:

  • All aspirin and NSAID’s (Aleve, Motrin, Advil, Naprosyn, Vioxx)
  • Anti-platelet medications (Plavix, Pletal, Ticlid, Aggrenox)
  • Gingko Biloba, Ginger, Garlic

5 days prior to your procedure:

  • All blood thinners (coumadin/warfarin)

2 days prior to your procedure:

  • Iron supplements

12 hours prior to your procedure:

  • Lovenox, Fragmin

What happens before your procedure?

This procedure will be performed at Penrose Hospital. Please check in for your ERCP two hours before your procedure time.

Stents

Another technique employed by your gastroenterologist to treat obstructions of the bile duct and pancreatic duct is the placement of plastic stents into the ducts. Here, an Associates in Gastroenterology physician has placed two stents into the bile duct, and one stent into the pancreatic duct to treat a stenosis (or narrowing).

What happens during the procedure?

The instrument will be inserted through the mouth and into the duodenum (small intestine). Your physician may instill water or air to help with visualization.

Various devices may be utilized by your Associates in Gastroenterology physician to access the biliary or pancreatic ducts. Each procedure’s goals will be targeted to individual patient needs and indications. Areas of abnormal tissue will be biopsied, and photos of the areas will be obtained and reviewed with you. A special incision in the muscle regulating the opening of the ducts, the sphincter of Oddi, may be made. This is called a sphincterotomy. If a biopsy or a sphincterotomy is performed, your physician will go over this with you afterwards and remind you not to take aspirin or NSAIDs for several days afterward.

What happens after your procedure?

After your procedure, you will be monitored and allowed to recover from the sedation. This typically takes 30 minutes to one hour. Your abdomen may be a little sore for a while, and you may feel bloating or cramping right after the procedure because of air introduced into your GI tract during the test.

With rare exceptions, most patients can resume a normal diet immediately afterwards.

You will go home with a copy of your procedure report, and your referring physician will receive a copy in the mail usually within one week.

What are the possible complications of an ERCP?

ERCP is generally safe and complications are rare when the test is performed by a Board-certified gastroenterologist, however, due to its inherent intent to image and possibly manipulate anatomy near or involving the pancreas, this is the most advanced procedure typically performed by a gastroenterologist, and the complication rate is higher than other endoscopic procedures. Your Associates in Gastroenterology physician will discuss this procedure at length with you before scheduling it.

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

Irritation or inflammation of the pancreas, known as pancreatitis, can occur in up to 10% of patients, sometimes up to 20% if your physician suspects Sphincter of Oddi dysfunction. Pancreatitis symptoms can include pain, nausea, and vomiting. The illness can be brief (hours), treated with pain medication at home, or rarely, involve observation in the hospital. Very rarely, pancreatitis can be severe, including destruction of the pancreas and even death. These severe complications are fortunately very rare, but can occur.

Rarely, a tear in the wall of the gastrointestinal tract could require hospitalization, emergency surgery, or even death.

Other rare risks include a reaction to the sedatives used or aggravation of heart or lung diseases.

Please call immediately if after the procedure you develop fever, significant pain, or bleeding.

ERCP General Instructions