Endoscopic retrograde cholangiopancreatography (ERCP) is a form of gastrointestinal endoscopy used to examine the bile and pancreatic ducts. ERCP procedures aim to assess and treat problems within the digestive system (including the pancreas, bile ducts, liver or gallbladder) to improve overall gut health and wellbeing through minimally invasive techniques.
In short, a flexible tube called a duodenoscope (fibre optic endoscope) is placed into your mouth and is slowly fed through your stomach until reaching the first part of the small intestine (duodenum). In the duodenum, there is a small opening called the ampulla. Through the ampulla, using specialised equipment, dye (contrast material) is injected and X-rays are taken to study the ducts of the pancreas and liver.
You may need an ERCP after an abnormal blood test result, ultrasound or CT scan to locate issues within your digestive tract or pancreatic and bile ducts that are causing daily discomfort. The most common reasons to do ERCP are for treatment of bile duct stones, common bile duct infections (cholangitis) or blockages, obstructive jaundice (yellowing of the skin) and to assist in the treatment of complications from gallbladder surgery (bile leaks). In patients with suspected or known pancreatic disease, an ERCP may help determine the need for surgery or the best type of surgical procedure to be performed. Occasionally, pancreatic stones can be removed by an ERCP procedure.
For an ERCP, your stomach must be empty, so you should not eat or drink anything for approximately 8 hours before the examination. Your doctor will be more specific about the time to begin fasting depending on the time of day that your test is scheduled. It is important to note that your current medications may need to be adjusted or avoided but most medications can be continued as usual. Medications such as blood thinners, supplements and insulin should be discussed with your doctor prior to the examination. After the ERCP examination, you will need someone to transport you home or stay with you overnight depending on the procedure.
An ERCP requires you to be extremely relaxed during the examination. You will be given medication intravenously and be completely asleep for your procedure via local anesthetic.
While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your oesophagus, and into your stomach and duodenum. The examination may require spray dye to pinpoint insights found or air inflation to the duodenum to identify potential concerns.
The procedure usually lasts for upwards of an hour but this timeframe may vary depending on the planned intervention. The vast majority of patients do not feel or experience any discomfort during the examination as they are usually asleep and able to breathe comfortably.
If the ERCP examination discovers other issues that are concerning, you may have to have further treatment by one of the following procedures:
After your ERCP procedure, you will be monitored in the endoscopy area for about 2 hours until the effects of the sedatives have worn off. Your doctor will usually inform you of your test results on the day of the procedure but it can be difficult to remember if you have had medication during your examination. It is a good idea to have someone with you to listen to what you were instructed to do after the procedure in case you forget. If you have any questions regarding your results or procedure after you have left, don't hesitate to contact your doctor.
Short Term Recovery. In the short term, you may feel immediate relief from your ERCP procedure with no pain or discomfort after the treatment. However, you should relax and rest on the day and the day after your examination as recovery generally takes a few hours to a few days. A mild sore throat and nausea are common effects of post-procedure but you should feel comfortable resuming your regular diet, level of activity, and bowel movements within a few days. Depending on your ERCP procedure you may be provided with dietary instructions from your doctor as you may not be able to process specific foods.
Long Term. ERCP recovery varies with the condition that has been treated with some requiring more extensive and involved long term care. There are chances of complications in the biliary and pancreatic ducts. Although not highly likely, you will need to watch for the signs of recurrent obstruction or blockages.
ERCP is safe when performed by doctors who have had specific training and are experienced in specialised endoscopic retrograde cholangiopancreatography. Serious complications are rare, however, they can occur.
Pancreatitis (inflammation of the pancreas) due to irritation of the pancreatic duct by the X-rays contrast material or cannula is the most common complication for ERCP patients to experience. This occurs in about 5% of patients and results in abdominal pain and nausea lasting a few days.
Gallstone recurrence is sometimes common after your first ERCP procedure removing them, if they have been treated effectively before you are not likely to experience them again.
Uncommon complications are:
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