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ERCP: Endoscopic Retrograde Cholangiopancreatography

Updated: Jul 4, 2018

Dr. Tim Chen is a gastroenterologist at Pacifica Digestive Health. He is also the Vice President and was one of the co-founders of Pacifica Digestive Health. His clinical interests include therapeutic endoscopy, hepatitis, inflammatory bowel disease, and esophageal motility disorders.

Pacifica Digestive Health Patient Education - Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is an ERCP?

ERCP Diagram
Diagram of an ERCP Procedure (Credit: By Cancer Research UK via Wikimedia Commons)

ERCP stands for Endoscopic Retrograde Cholangiopancreatography, a highly specialized endoscopic procedure. ERCP helps to diagnose and treat issues in the bile and pancreatic ducts such as stones, strictures (narrowing of the vessels) and blockages. This procedure is carried using a long, thin, flexible tube with a camera on one end, called an endoscope to inject dye into the duodenum, pancreas, bile ducts and gallbladder.

Breaking down the word, we have:

  • Endoscopic - using an endoscope

  • Retrograde - this is the backward direction in which the endoscope injects an X-ray-visible liquid into parts of the gastrointestinal tract called the pancreas and bile duct systems.

  • Cholangio - refers to the bile duct system

  • Pancreatography - refers to the pancreas. With the above, it is the process of taking X-rays of the bile duct and pancreas.

ERCP cholangiogram
A cholangiogram during an ERCP (Credit: By J. Guntau via Wikimedia Commons)

What is the Purpose of a ERCP?

The dye injected into the pancreas and bile duct is used so that your doctor can detect any abnormalities in your pancreas or bile duct. The following are conditions can lead to an ERCP procedure:

  • If there is a narrowing or blockage in your biliary or pancreatic ducts, caused by tumors, stones or scarring.

  • To investigate the cause of abnormal liver chemistry tests, ultrasound, CT scan or MRI exam.

  • To relieve jaundice caused by blocked bile ducts. Jaundice is a condition characterized by your skin and/or the whites of your eyes turning yellow.

  • To find the cause of pancreatitis, pancreatic inflammation, or to prevent future attacks.

  • ERCP may be performed in place of surgery in some cases.

What to Expect During an ERCP?

Generally, a doctor or nurse will give you all the necessary information you need to prepare for your ERCP. Below are general guidelines that you should follow as well.

  • Ensure you disclose all medications you are currently taking and any allergies you are aware of. This includes both OTC and prescription drugs, vitamins and supplements. Ask your doctor if you should continue taking the medication before the procedure.

  • Tell your doctor if you have any pre-existing conditions. This includes diseases such as diabetes, heart or lung problems, or if you have issues with blood clotting.

  • Inform your doctor if you have a pacemaker or any other electromechanical device implanted in you.

  • Disclose previous stomach or bowel surgeries, swallowing or other GI problems.

  • Do not eat or drink anything at least 6 hours before your procedure.

  • Have someone with you to take you home after the procedure as you will not be fit to drive.

ERCP are usually done at the hospital because of the advanced equipments required and the complexity of the procedure.

During the procedure, the doctor will give you an IV (Intravenous line) of fluids and medication to sedate you. If you have any questions, this is the time to bring them up with your doctor as he reviews your consent form.

Your doctor will ensure that you are comfortable throughout the procedure. You may feel full since air may be put in to help move the scope along. The back of your throat may be sprayed with numbing medication. The endoscope will then be passed through your mouth, into your stomach and duodenum. When in the duodenum, a smaller tube is put through the endoscope into the pancreas or bile duct. The dye will make any problems visible. If need be, a biopsy may be carried out.

After the procedure, you may experience minor issues such as bloating and passing gas but this should subside after 24 hours. If a biopsy was done, you shall be told when to back for your results or a review.

ERCP is an effective, easy way to detect problems in the pancreas and bile duct and may help you avoid surgery.

What Are the Risks and Complications of an ERCP?

In general, endoscopic retrograde cholangiopancreatography (ERCP) is a very safe procedure. Most complications are not life-threatening, however, if a complication occurs, it may require hospitalization and surgery. These complications include

  • Pancreatitis, or inflammation of the pancreas, can occur in 5-8% of patients. Symptoms include fevers, abdominal pain, nausea/vomiting.

  • Gastrointestinal bleeding. However, significant bleeding requiring blood transfusion is very uncommon.

  • Perforation or puncture of the esophagus, stomach, or small intestines, which may be recognized at the time of exam or may not be apparent until later.

  • Medication reactions associated with sedation, including allergic reactions and affects on heart and blood pressure.

Finally, for a variety or reasons, in 5-10% of cases, the exam may not be able to be completed.

It is very important that the patient contact the doctor's office immediately if symptoms arise after the procedure such as worsening abdominal pain, bleeding, or fever.

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