Endoscopic Retrograde Cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that uses X-ray to view the patient's bile and pancreatic ducts. This is performed using an endoscope which is passed into the duodenum to cannulate the common bile duct with special tools. The most common indication for this investigation is to evaluate and relieve any blockage of the bile ducts. The procedure is performed under sedation or general anaesthesia, to avoid any pain or discomfort to be experienced during the procedure.

Many patients who need ERCP are hospitalized, but ERCP can also be performed as an outpatient procedure, depending on the patient's condition and on the complexity of the required procedure.

ERCP Preparation

You will be asked not to eat or drink anything for six to eight hours before the test. It is important for the stomach to be empty to allow visualization 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. Some medications need to be discontinued for several days. All medications and dietary supplements should be discussed with your doctor, as some might need to be discontinued. If you are pregnant, the ERCP should be postponed until after childbirth if possible, but if the procedure is urgent, it can be done safely during pregnancy.

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

ERCP Procedure

ERCP is performed in a room that contains X-ray equipment. You will lie on a special table during the examination, generally on your left side or stomach.

Although many people worry about discomfort from the endoscopy, most people tolerate it well and feel fine afterwards.

Medications will be given through the IV line during the procedure. A plastic mouth guard is placed between the teeth to prevent damage to the teeth and endoscope. Many patients sleep during the test; others are very relaxed and not aware of the examination.

The ERCP endoscope is a special flexible tube, approximately the size of a finger. It contains a lens and a light source that allows the doctor to view the upper gastro-intestinal system.

Depending on what the gastroenterologist sees during the ERCP, a variety of procedures or treatments may be performed. If bile duct stones are present in the common bile duct, the opening of the papilla can be widened, and the stones are removed by a basket. 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 examination varies, between 30 and 90 minutes (usually about an hour).

Recovery after ERCP

After ERCP, you will be monitored while the sedative medications wear off.

The most common discomfort after the examination is a feeling of bloating as a result of the air introduced during the examination. This usually resolves quickly. Some people also have a mild sore throat. Most people are able to drink clear liquids shortly after the examination. In some cases, blood tests may be done the same day following ERCP.

ERCP Complications

ERCP is a safe procedure and serious complications are uncommon. If complications do occur, they are usually mild, and may include the following:

The following symptoms should be reported immediately:

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