ERCP

Overview

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that enables your doctor to examine the bile and pancreatic ducts. A special fibre optic endoscope (duodenoscope) is placed through your mouth and into your stomach and first part of the small intestine (duodenum).

In the duodenum a small opening is identified (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.

Reasons you may need an ERCP

ERCP is most commonly performed to treat conditions of the pancreas or bile ducts. The most common reasons to do ERCP are for treatment of bile duct stones, bile duct infections (cholangitis) , obstructive jaundice (yellowing of the skin) and to assist in treatment of complications from gallbladder surgery (bile leaks). In patients with suspected or known pancreatic disease, 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 ERCP.

Preparation

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. Your current medications may need to be adjusted or avoided. Most medications can be continued as usual. Medications such as blood thinners and insulin should be discussed with your doctor prior to the examination.

Procedure

You will be given medication intravenously to help you relax during the examination. You will be completely asleep for your procedure. While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your esophagus, and into your stomach and duodenum. The procedure usually lasts about an hour, but this may vary depending on the planned intervention. The vast majority of patients do not feel or experience any discomfort during the procedure, as they are usually asleep during the procedure.

Recovery

You will be monitored in the endoscopy area for about 2 hours until the effects of the sedatives have worn off. Your throat may be sore for a day or two. Your doctor will usually inform you of your test results on the day of the procedure. Biopsy results take several days to return, and you should make arrangements with your specialist to get these results. The effects of sedation may make you forget what you were instructed to do after the procedure.

Complications

ERCP is safe when performed by doctors who have had specific training and are experienced in this specialized endoscopic procedure. Complications are rare, however, they can occur. Pancreatitis due to irritation of the pancreatic duct by the X-ray contrast material or cannula is the most common complication. This occurs in about 5% of patients. Bleeding, infection and perforation (an inadvertent hole in the intestine or bile duct) are relatively infrequent complications. A reaction to the sedatives can occur. It is important for you to recognize the early signs of possible complications and to contact your doctor if you notice symptoms of severe abdominal pain, fever, chills, vomiting, or rectal bleeding.

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