What Is ERCP?
Endoscopic retrograde cholangiopancreatography (ERCP) is a
test used to find and treat abnormalities in your pancreas, bile ducts, and
gallbladder. ERCP is a combination of two tests: an endoscopy and an X-ray.
An endoscopy is a procedure in which a thin, flexible tube
attached to a tiny camera is threaded down to your gastrointestinal (GI) tract.
Your GI tract consists of your esophagus, stomach, and intestines.
This camera will be used to take an X-ray of the insides of
your bile ducts and pancreatic ducts. Your bile ducts are also sometimes called
biliary ducts. The ERCP can help your doctor find and treat any blockages in
these ducts. The results will also help them diagnose the reason for the
Why Is ERCP Used?
Your pancreatic and bile ducts play an important role in
Your pancreas releases enzymes that help with your digestion
and mix with bile. Bile helps you digest fat. Bile is produced by and stored in
your liver, and delivered to your gallbladder through your bile ducts.
Problems with your gallbladder or liver can block your body’s
ability to absorb nutrients. These problems include a narrowing of the ducts. You
can also develop jaundice, a yellowing of your skin and the whites of your
eyes, if your liver isn’t working properly.
ERCP can help your doctor diagnose blockages in your
pancreatic and bile ducts. In some cases, your doctor can also provide
treatment during ERCP to address these blockages.
Preparing for ERCP
The doctor performing your ERCP must be able to see your GI
organs clearly. This is easier when your stomach is empty, so you will be asked
to fast beforehand. Do not eat or drink after midnight if you’re scheduled for
a morning ERCP. Your doctor will usually ask you to fast for eight hours if
your procedure is scheduled for later in the day. You should also avoid smoking
or chewing gum during this time.
Let your doctor know about all medications, vitamins, and
supplements you take. You might be asked to temporarily stop taking medications
that contain aspirin or other blood thinners. Examples of these medicines can
- naproxen sodium
Tell your doctor about any food and drug allergies you have.
You should also let your doctor know if you’ve had bad reactions to contrast
dye in the past.
The ERCP Procedure
For most people, ERCP is performed as an outpatient
procedure. This means you won’t have to stay overnight in the hospital.
The procedure involves the following steps:
You will receive sedative medication intravenously (through
a vein) in your arm to help you relax during the ERCP. Your doctor might also
spray a general anesthetic in your throat. This helps the endoscope enter your
throat and digestive system with little discomfort. You will be awake but you
will probably feel sleepy during the procedure.
The doctor who performs the ERCP is a gastroenterologist.
This is a specialist who studies the gastrointestinal tract. You will lie down
on an X-ray table, which will be used to take the images. Your
gastroenterologist will thread the endoscope down your esophagus to your
stomach and the upper part of your small intestine. The camera attached to the
end of the endoscope will transmit a video feed that they can view on a
computer during the procedure.
Your doctor might also use the endoscope to pump some air
into your stomach. The air helps them gently push the scope through to the
upper area of your intestines, called the duodenum.
3. Catheterization and Contrast Dye
A small opening in your intestines connects your bile ducts
with your duodenum. This opening is called the papilla. Your doctor will put a
tube called a catheter into your papilla and inject contrast dye through it in
a retrograde, or backward flow, pattern. Contrast dye is a fluid that
highlights the ducts to make them more visible on an X-ray. The catheter carries
the contrast dye to your pancreatic or biliary ducts.
The contrast dye helps any abnormalities in your ducts show
up on the X-ray images taken during the procedure. Your doctor will view the
X-ray images at a later date.
Abnormalities can include narrowed areas, scar tissue, and
blockages. Narrowed spots in the ducts are called strictures. Blocked ducts may
be caused by gallstones, a solid mass of hardened bile, or tumors.
In many cases, these abnormalities can be treated during your
ERCP. Your doctor will use X-ray video, also known as fluoroscopy, to see the
ducts while carrying out treatment.
Your doctor may place a tiny tube in the duct to treat
strictures. The tube, called a stent, is placed into the duct through your
doctor’s endoscope. Gallstones can be removed or dissolved through the
endoscope as well.
When the procedure is over, you will be moved to a room
where you can recover. Once the sedative has worn off, you can go home. You
should have someone available to give you a ride. You’ll probably feel tired,
so take it easy for the rest of the day.
Potential Risks and Complications
ERCP is generally a very safe procedure. The American Gastroenterological
Association estimates that only 5 to 10 percent of people suffer from
complications related to ERCP. The most common risk is inflammation of the
pancreas. Some people may have a sore throat from the endoscopy for a few days.
Excessive bleeding may occur in a small number of people. You
face a higher risk of bleeding if you have stones removed from your bile ducts
during the procedure. Puncture of the bile duct or bowel wall and infection are
rare risks of ERCP. These complications may require hospitalization.
A doctor known as an interventional radiologist will take a
look at the X-ray images produced during the ERCP. Once your doctor gets the
results from the interventional radiologist, they will contact you to discuss them
and talk about a plan of action. The results can help your doctor learn why
your ducts are blocked. For example, they may be blocked due to inflammation of
your pancreas or biliary tumors. Medications or surgery may be required to
treat these conditions.
Recovery from ERCP
After your ERCP, you will be monitored for a brief recovery
time. If your blood pressure and oxygen levels remain normal, and you become
more alert, you can go home. Bring someone to drive you home, since you may
still be drowsy after your procedure.
Notify your doctor if you experience severe abdominal pain,
vomiting, fever, or blood in your stool.
Gas is the most common complaint after ERCP. Soft stools may
also be a temporary side effect of the procedure. You can return to a normal
diet and work schedule as soon as you feel ready.