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Endoscopic Retrograde Cholangiopancreatography
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Endoscopic Retrograde Cholangiopancreatography

(ERCP)

Pronounced: en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee

En Español (Spanish Version)

Definition

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure done to treat and diagnose problems in the liver, gallbladder, bile ducts, and pancreas. ERCP uses a combination of endoscopy (the use of a flexible fiberoptic camera to look into your digestive system) and x-rays.

Parts of the Body Involved

  • Mouth
  • Esophagus
  • Stomach
  • Small intestine
  • Liver
  • Gall bladder
  • Bile ducts
  • Pancreas

Reasons for Procedure

Your doctor may advise you to have an ERCP if you are suspected of having one of the following:

  • Blockage of the bile duct
  • Pancreatic duct blockage
  • Leaky duct
  • Pancreatitis
  • An abnormal tissue growth or scarring in the bile duct or pancreatic duct
  • Jaundice
  • Tumor (cancer)

Risk Factors for Complications During the Procedure

  • Bleeding disorder
  • Young age
  • Female sex
  • History of ERCP-related pancreatitis
  • Sphincter of Oddi dysfunction
  • Pregnancy
  • Recent or chronic illness
  • Heart or lung problems

What to Expect

Prior to Procedure

  • Do not eat for 8-12 hours before the procedure.
  • If you have diabetes, discuss your medications with your doctor.
  • If you are on blood thinning medications, discuss them with your doctor.
  • Arrange for transportation after the procedure. (You should not drive for 24 hours after the procedure.)
  • Inform your doctor if you have had previous allergic reactions to dyes.

Anesthesia

  • Your throat may be sprayed with a medicine to make it numb.
  • You will be given intravenous (IV) medications to help you relax.
  • If your doctor thinks your ERCP will take a long time, he or she may recommend you have general anesthesia for your procedure.

Description of the Procedure

This procedure is done in an x-ray room. During the procedure, you will lie on your stomach with your head turned to the right. Your doctor will put a mouthpiece in your mouth to help keep it open. An assistant will be in the room to monitor your breathing and heart beat. Your doctor will put an endoscope (a long, flexible fiberoptic camera) into your mouth and slowly pass it through your throat and into your esophagus, stomach, and/or small intestine.

As your doctor inserts the endoscope, he or she will watch the images on a video monitor. He or she will also pass air through the scope to see better. Your doctor will push the endoscope into the place where the ducts of the biliary system (which transport bile out of the liver) and pancreas (which makes digestive juices) open into the small intestine.

Next, he or she will advance a small tube through the endoscope into the opening of the bile and pancreatic ducts. Through this tube, your doctor will inject a dye that goes into the ducts and makes them show up on the x-ray machine.

If a gallstone shows up on the images, your doctor may attempt to remove it through the endoscope. Scarring or narrowing within the ducts can also be treated with instruments passed through the scope. Biopsies (tissue samples) can be taken through the scope and sent to a laboratory for further testing.

Endoscopic Retrograde Cholangiopancreatography

Nucleus Image

© 2008 Nucleus Medical Art, Inc.

After Procedure

You will be observed in a recovery area for at least one hour after your procedure before you are sent home.

How Long Will It Take?

The procedure will take anywhere from 30 minutes to two hours.

Will It Hurt?

During the procedure, you may feel discomfort in your throat. After the procedure, your throat may be sore for a few days. In addition, you may feel bloated and need to belch.

Possible Complications

  • Perforation (puncture) of the esophagus, stomach, small intestine, or bile duct
  • Pancreatitis (inflammation of the pancreas)
  • Infection
  • Bleeding
  • Death (rare)

Average Hospital Stay

If the ERCP is only diagnostic, you may go home the same day. However, if you have other procedures done through the scope, you may need to stay in the hospital overnight.

Postoperative Care

  • Do not drive for at least 24 hours.
  • Rest the remainder of the day.
  • Resume your normal diet, unless told otherwise by your doctor.
  • Do not drink alcohol for 24 hours after your procedure.
  • Resume your medications, unless told otherwise by your doctor.
  • Ask your doctor when it is safe to resume anticoagulation medications (such as ibuprofen, aspirin, or warfarin).

Outcome

After ERCP you may have relief of your problem. Treating obstruction of the bile duct or pancreatic duct with ERCP can make surgery unnecessary.

Call Your Doctor If Any of the Following Occurs

  • You develop nausea
  • You develop severe abdominal pain
  • You have a fever
  • You vomit blood
  • You pass black, tar-like stools

RESOURCES:

American Gastroenterological Association (AGA)
http://www.gastro.org

American Society for Gastrointestinal Endoscopy
http://www.asge.org

National Digestive Diseases Information Clearinghouse (NDDIC)
http://digestive.niddk.nih.gov/index.htm

CANADIAN RESOURCES:

BC Health Guide, British Columbia Ministry of Health
http://www.bchealthguide.org

Canadian Digestive Health Foundation
http://www.cdhf.ca

References:


Cohen S, Bacon BR, Berlin JA, et al. National Institutes of Health State-of-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14-16, 2002. Gastrointest Endosc . 2002 Dec;56(6):803-809.

Feldman M. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease . 7th ed. Philadelphia, PA: Saunders; 2002.

Yamada, T. Textbook of Gastroenterology . 4th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2003.



Last reviewed March 2008 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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