Endoscopic Retrograde Cholangiopancreatography

What is an ERCP?

An endoscopic retrograde cholangiopancreatography is a test that involves using an endoscope-a flexible, telescope-like instrument to take X-ray pictures of the ducts that drain your liver (bile ducts) and pancreas. Through the endoscope, the physician can see the inside of the stomach and duodenum, which is the first part of your small intestine, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x-rays. The doctor uses this procedure to detect any abnormalities in these ducts, such as gallstones or blockages, strictures (narrowing), tumors, or cysts.

Other procedures may be performed while the endoscope is in your duodenum. These procedures may include stretching or enlarging a narrowed duct; removing blockages, like gallstones; or taking cell samples for further study.

Procedure

For the procedure, you will lie on your left side on an examining table in an x-ray room. You will be given medication to help numb the back of your throat and a sedative to help you relax during the exam. You will swallow the endoscope, and the physician will then guide the scope through your esophagus, stomach, and duodenum. At this point, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them clearly visible on X-rays. X-rays are taken as soon as the dye is injected. If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Possible complications of ERCP include inflammation of the pancreas (pancreatitis), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon.

ERCP takes 30 minutes to two hours. You may experience some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the hospital for one to two hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.

Preparation

For this procedure to be accurate and safe, your stomach and duodenum must be empty. Do not eat or drink anything after midnight the night before the procedure, or for six to eight hours before the time of your procedure depending upon the time it is preformed. Also, inform the physician whether you have any allergies, especially to iodine, which is in the dye. You must also arrange for someone to take you home-you will not be allowed to drive because of the sedatives. The physician may give you other special instructions.