ERCP

What is endoscopic retrograde cholangiopancreatography (ERCP)?
ERCP is a way to evaluate the bile ducts that drain your liver and to examine your pancreas. After making the patient comfortable and sleepy with medications, a flexible camera instrument (endoscope) is passed through the mouth into the first part of the small intestines (duodenum) where the openings to the bile and pancreas ducts are located. With delicate instruments, x-rays and contrast, your doctor is able to carefully evaluate your bile ducts and pancreas. ERCP allows your gastroenterologist to remove bile duct or pancreatic duct stones by widening opening (sphincterotomy) and by fragmenting the stones (lithotripsy). Plastic or metal tubes can be used to treat strictures (narrowed area causing blockage). If needed, tissue samples can be taken painlessly from the bile duct and pancreas opening (papilla) or from within the bile ducts by ERCP.

When may ERCP be necessary?
To evaluate and treat certain types of jaundice
To evaluate and treat suspected stones in the bile duct or pancreatic duct
To evaluate and treat blockages of the bile duct and pancreatic duct
To evaluate and treat leaks of the bile duct and pancreatic duct
Suspected pancreas cancer

What are some alternatives to ERCP?
Surgery is more invasive and requires general anesthesia, but is sometimes required if ERCP cannot treat the medical condition.

Percutaneous trans-hepatic cholangiogram (PTC) is a procedure where a needle is used to puncture the skin to gain access to the bile ducts. PTC is usually only used if ERCP cannot be performed because PTC has higher risks of bleeding, infection and damage to organs and blood vessels.

You should ask your doctor about these other choices.

How do I prepare for an ERCP?
Follow the physician’s instructions. Avoid any aspirin, ibuprofen, naprosyn or other non-steriodal anti-inflammatory drugs (NSAIDS) for 10 days prior to the procedure. Avoid any anti-platelet agents such as Plavix (clopidogrel), Ticlid (ticlopidine) and Aggrenox for 10 days prior to the procedure. Stop Coumadin (warfarin) for 5 days prior to the procedure. If you take any of these medications regularly, ask your primary care physician what to do before stopping them, your physician may advise you to take Lovenox or otherwise. Eat a light meal the night before the operation and do not eat or drink anything after midnight the night before the procedure. Plan for care and recovery time after your ERCP is over. You may be required to stay overnight in the hospital for observation.

What happens after the procedure?
After the examination, you will be taken to a recovery area. Many people have little recollection of the procedure because of the amnesic effects of the medicine. After the procedure, you will feel drowsy and may sleep for a short time. The effects of the medicine will wear off quickly, but you will not be allowed to drive yourself home, as it is unsafe. You may experience a bloated sensation due to the air introduced into your stomach during the procedure, but this discomfort will resolve if you belch and expel the air. Before you leave the endoscopy center, your doctor will discuss the procedure findings and treatment plans with you. You should have a family member or trusted friend present during this discussion, as the medication you received may make you forgetful. Our nursing staff will provide you with a written copy of the findings and treatment instructions, as well as handouts on appropriate topics.

If a sphincterotomy (widening the bile duct or pancreatic duct opening with a small cut) is performed, you will need to avoid aspirin, ibuprofen, naprosyn or other non-steriodal anti-inflammatory drugs (NSAIDS) and any “blood-thinners” such as Plavix (clopidogrel), Coumadin (warfarin) or Ticlid (ticlopidine) for at least 10 days after the procedure. Take Tylenol (acetaminophen) instead if approved by your primary care physician.

Ask your doctor for specific instructions and when you should come back for a checkup.

What are the benefits of this procedure?
Bile duct stones or strictures can cause jaundice (yellowing of the skin and eyes) as well as severe itching. If left untreated, patients can become very ill with serious blood infections, bleeding problems and liver disease. ERCP is the standard-of-care to treat many of these disorders and to prevent these possible problems.

What are the risks associated with this procedure? Today, ERCP is a routine procedure and problems rarely occur. Some risks include but are not limited to: pancreas inflammation (pancreatitis), bleeding that may require blood transfusions, perforation or tear, damage to area, infection that may require antibiotics and hospitalization, heart or lung problems. If problems occur you may require surgery or hospitalization that could rarely be prolonged.

When should I call the doctor?
Call the doctor immediately if you develop abdominal pain, nausea or vomiting that does not resolve; or if you develop a fever.

Call the doctor during regular office hours if you have questions about the procedure or its result; or if you wish to make another appointment.

Outside links to understanding ERCP:
ASGE
ASGE (Therapeutic ERCP)
NIDDK