ERCP (short for endoscopic retrograde cholangiopancreatography) is a procedure used to diagnose diseases of the gallbladder, biliary system, pancreas, and liver. The test looks “upstream” where the digestive fluid comes from — the liver, gallbladder, and pancreas — to where it enters the intestines. In addition, ERCP can be used to treat problems in these parts of the digestive system.
ERCP is a highly specialized procedure that should be performed by experienced, skilled physicians. ERCP combines the use of endoscopy and fluoroscopy to visualize the bile ducts and pancreatic duct.
Endoscopy– physician inserts a thin, flexible tube with a light and camera at the end to visualize structures within the digestive tract
Fluoroscopy– X-rays are performed while contrast (a radiopaque liquid) is injected into the bile ducts and/or pancreatic duct to visualize the anatomy.
ERCP is an advanced endoscopic technique that was initially developed in the early 1970s for the diagnosis and treatment of disorders within the bile ducts and pancreas. It offers a less invasive, endoscopic approach than traditional surgical procedures for the biliary and pancreatic ducts. Using a specialized endoscope and fluoroscopy (X-rays), the physician passes the endoscope through the mouth to gain access to the bile duct and/or pancreatic duct from the first portion of the small intestine (duodenum).
During ERCP, you are deeply sedated with either propofol-based anesthesia or general anesthesia (similar to surgical procedures) by a skilled anesthesiologist or certified registered nurse anesthetist. In general, ERCP takes approximately 30-90 minutes to perform. Following the procedure, you will be monitored in the recovery area, and the physician will then determine whether you can be discharged home, accompanied by a responsible adult, or admitted to the hospital for further observation.
Why is ERCP performed?
ERCP is used to diagnose and treat a variety of complex gastrointestinal disorders. The following is a list of common indications for ERCP.
- Diagnosis and treatment of common bile duct stones
- Diagnosis and treatment of strictures (blockage) involving the bile ducts and pancreatic duct
- Removal of pancreatic duct stones (complication of chronic pancreatitis)
- Treatment of Sphincter of Oddi Dysfunction (SOD)
- Diagnosis and treatment of recurrent acute pancreatitis
- Treatment of bile leaks following gallbladder surgery or trauma to the bile ducts
- Treatment of pancreatic duct leaks from acute or chronic pancreatitis or trauma to the pancreas
- Removal of tumors involving the major duodenal papilla (ampullary polyps)
What is an Endoscopic Sphincterotomy?
During an ERCP, sometimes the physician will need to perform a sphincterotomy to either obtain access to the bile duct or remove bile duct and pancreatic duct stones. During a sphincterotomy, the sphincter muscle that controls the drainage of bile and/or pancreatic juice is cut with a sphincterotome (small wire connected to electrocautery).
What to Expect on the day of your ERCP?
Prior to your procedure, you will need to follow specific preparation instructions. The following is a list of general instructions prior to the procedure.
- You may not eat or drink for six to eight hours prior to the procedure to ensure that the intestinal tract is clear of food products.
- Arrive one to two hours prior to the scheduled procedure time to allow ample time for registration and preparation
- Please inform your physician of any medication allergies.
- Your physician will instruct you regarding any prescription medications you are taking. In general, coumadin (warfarin) should be held five days prior to the procedure, and plavix (clopidogrel) should be held seven days prior to the procedure. Holding these medications should be discussed with your physician prior to the procedure.
- An IV will be inserted to allow administration of fluids and sedatives.
- Following sedation, an endoscope will be inserted through the mouth to the first portion of the duodenum where access to the bile duct and/or pancreatic duct is obtained.
- Upon completion of the procedure, you will be monitored in the recovery area where the physician will discuss the findings of the procedure and determine whether you can be discharged home, accompanied by a responsible adult, or admitted to the hospital for further observation.
What are the risks or potential complications of ERCP?
The largest risk associated with ERCP is pancreatitis (generally a 5-10% risk). Pancreatitis is inflammation of the pancreas and can cause severe abdominal pain associated with nausea and vomiting requiring admission to the hospital for intravenous fluids and narcotics for pain control. Sometimes, the physician will place a small, temporary plastic stent within the pancreatic duct to reduce the risk of post-ERCP pancreatitis. If a pancreatic stent is placed, an abdominal X-ray is performed within 2-4 weeks to determine if the stent has spontaneously migrated into the intestinal tract or remains within the pancreatic duct. If the stent remains in the pancreatic duct, the stent will need to be retrieved with a repeat upper endoscopy. Other potential complications include bleeding, infection, ductal injury and perforation. However, these complications are less frequent than pancreatitis.
How Should I Prepare for ERCP?
Before having ERCP, let your doctor know about any special medical conditions you have, including:
- Lung Conditions
- Heart Conditions
- Allergies to any medications
If you have diabetes and use insulin you may need to adjust the dosage of insulin the day of the test. Your diabetes care provider will help you with this adjustment. Bring your diabetes medication with you so you can take it after the procedure.