What is an ERCP?

Endoscopy is the examination of an internal body part with an instrument called an endoscope. Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that uses X-ray to view the patient’s bile and pancreatic ducts.

The functions of the common bile duct and the pancreatic duct are to drain the gallbladder, liver, and pancreas; the two main ducts convey the bile and the pancreatic juice through the papilla into the duodenum (the first part of the small intestine).

We will examine the bile and/or pancreatic ducts, looking for abnormalities such as blockages, irregularity in the tissue, problems with the flow of bile or pancreatic fluid, stones, or tumors. If a problem is found, we can often perform a procedure to repair or improve the condition; as a result, ERCP has replaced surgery in most patients with common bile duct and pancreatic disease.

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.

Why would I need an ERCP?

The most common reason why someone would need an ERCP is because of a blockage of one of these ducts (often due to gallstones). Prior to ERCP, blood tests and noninvasive imaging tests such as ultrasound, computed tomographic (CT) scan or magnetic resonance imaging (MRI) may need to be performed.

How do I prepare for an ERCP?

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 us to visualize 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. Most drugs can be continued as usual, but some medications need to be discontinued for several days. All medications and dietary supplements should be discussed with your doctor. For example, if you are taking blood-thinning medication, the doctor will determine how and when you should stop taking this prior to ERCP. If you are diabetic, adjustments will be made to your  medication dosages (tablets or insulin) because you cannot eat anything before your ERCP.

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).

What is the 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. The length of the examination varies between 30 and 90 minutes (usually about an hour).

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 us to view the inside of your body; images are magnified on a monitor so that even very small details and changes can be seen. The endoscope also contains channels that allow the endoscopist to take biopsies (painless tissue samples) and introduce or withdraw fluid, air, or other instruments.

You will be asked to swallow the tube; most people have no difficulty with this as a result of the sedating medications. Once the scope is inserted through the mouth, air is gently introduced to open up the esophagus, stomach, and intestine so the scope can be passed through those structures and to allow us to see. A small plastic tube (cannula) is passed through the endoscope into the opening of the bile duct through a structure called the papilla, dye is injected, and X-ray pictures are taken after the injection and displayed on a TV monitor so we can examine the bile ducts and pancreatic duct.

Depending on what we see during the ERCP, a variety of procedures or treatments may be performed.

You may experience mild discomfort as air is introduced through the endoscope. This is not harmful and belching may relieve the sensation. The endoscope does not interfere with breathing. Taking slow and deep breaths during the procedure may help you to relax.

How do I recover from ERCP?

After ERCP, you will be monitored while the sedative medications wear off. The medicines cause most people to temporarily feel tired or have difficulty concentrating, so it is usually advised not to return to work or drive that day.

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.

We can usually tell the patient the results of their examination right away. If biopsies were taken, the tissue will need to be sent to a lab for analysis.