ERCP Procedure
Definition
ERCP (Endoscopic Retrograde CholangioPancreatography) is a procedure performed with a camera (endoscope) inserted into the mouth allowing direct evaluation of the bile ducts, gallbladder and pancreas. It is a test performed to both diagnose diseases or conditions and also to treat them. The most common reasons to perform ERCP are to diagnose and treat gallstones and common bile duct stones, bile duct or pancreatic duct blockages that result in jaundice (yellowing of the skin and eyes), to rule out pancreatic or bile duct cancer, and to fix leaks from the bile duct and pancreatic ducts after surgery or traumatic events.
Procedure
The endoscope (camera) is a narrow flexible tube about the diameter of your little finger. Placing the tube over the tongue into the esophagus can be unpleasant and provoke gagging. To avoid this, you will be given sedating drugs through an intravenous that is placed in your hand or arm. Local anesthetic spray is applied to the back of the mouth to provide further comfort. An ERCP averages 30 minutes in duration, but may be shorter or longer depending on the complexity of the case. While you are sedated and the procedure is happening, we will use a small amount of x-rays and dye injected into your bile duct or pancreas to allow us to do identify any problems. The dose of x-rays is not harmful to you in any way, however notify us if you are or may be pregnant, as we will take special precautions to further reduce the amount of x-rays used.
Preparation
The only preparation required prior to undergoing an ERCP is fasting (not eating or drinking) for at least six hours before the test. If there is any food or liquid in the stomach this increases the risk of vomiting and choking AND increases the difficulty of the test for the physician, which can lead to incomplete procedures or the need for repeat procedures. If you become very thirsty you may have small sips of water for comfort, but please do not take anything else. Take all your medications you are on prior to the procedure as you normally would with a small amount of water or clear fluids.
The only exception is blood thinning medications and anticoagulants such as Plavix, Dalteparin, Heparin, Dabigatran, Abixiban (Xarelto) and Warfarin/Coumadin which should be stopped 3-5 days prior to the procedure in MOST cases. Please notify your physician or our nursing staff prior to the procedure if you are on one of these medications.
If you are diabetic and on insulin, please do not take your morning dose of insulin as you will not be eating prior to the procedure.
Risks
ERCP is generally one of the safest and least invasive method used to directly evaluate and perform therapies on the bile duct and pancreatic duct but it is still associated with several risks including: acute pancreatitis (severe epigastric pain and inflammation in 2-5% of cases), bleeding (less than 1% of cases), and perforation (making a hole in the stomach, or small intestine, in 1 in 1000 cases). Rarely the sedating medications used to make you comfortable can result in breathing difficulties or heart problems, although this is rare, and generally only occurs in the setting of pre-existing heart or lung problems. If there is any concern at the time of the procedure that one of these complications has occurred you may be asked to stay the night in hospital for observation for 1 or more days.
If upon going home you develop severe pain in the middle of the abdomen, fever higher than 38.5 degrees Celsius, vomit blood, or see unusual black stool for greater than 1 day, present to the emergency room for evaluation and call our offices.
Post Procedure
You will be monitored for around 30 minutes to 1 hour while you wake up from the sedatives. You may have some bloating, intestinal gas, and occasionally have nausea or mild abdominal pain that may last up to 24 hours. This is generally a result of any therapies we performed and some degree of discomfort can be expected. Eat only light foods such as soups, jello, tea/coffee, and juices for the remainder of the day of your procedure.
Going Home
Due to sedation you will not be fit to drive until the following day. It is therefore mandatory that you have someone to drive you home after the test, and preferably to stay with you for the evening/night after the test if possible.