Digestive Diseases: ERCP

ERCP (short for endoscopic retrograde cholangiopancreatography) is a procedure used to diagnose diseases of the gallbladder, biliary system, pancreas, and liver. In addition, ERCP can be used to treat problems in these parts of the digestive system.

What Happens During the Procedure?

During the procedure, an endoscopist, usually a gastroenterologist (doctor who specializes in treating diseases of the gastrointestinal system), uses a special endoscope (a long, flexible tube with a light and camera at the end) to examine the inside of the digestive system. The endoscopist identifies the place where the bile duct comes into the intestine and then feeds a tiny catheter (a plastic tube) into the duct and squirts in a contrast agent while X-rays are taken. The contrast agent allows the doctors to see the bile ducts, the gallbladder and the pancreatic duct on the X-rays.

Once the source of the problem is identified, the doctor may then treat it by performing one of the following procedures.

• Sphincterotomy. This involves making a small incision in the opening of the pancreatic duct or the bile duct, which can help small gallstones, bile and pancreatic juice to drain appropriately.
• Stent placement. A stent is a plastic drainage tube that is placed in the bile duct or the pancreatic duct and allows it to drain.
• Gallstone(s) removal.

Is the Procedure Safe?

An ERCP is considered a low-risk procedure; however, complications can occur. These can include pancreatitis infections, bowel perforation and bleeding. Patients undergoing ERCP for treatment, such as for gallstone removal, face a higher risk of complications than patients undergoing diagnostic ERCP. Your doctor will discuss your risks of possible complications before the test.

How Should I Prepare for the Procedure?

Let your doctor know about any special medical conditions you have, including:

• Pregnancy.
• Lung conditions.
• Heart conditions.
• Allergies to any medications.
• If you have diabetes and use insulin. You may need to adjust the dosage of insulin the day of the test. Your diabetes care provider will help you with this adjustment. Bring your diabetes medication with you so you can take it after the procedure.
• If you are taking blood-thinning medications such as Lovenox, Coumadin, aspirin, Persantine or Plavix, your primary doctor may prescribe an alternate method for thinning your blood before the procedure.

Do not discontinue any medication without first consulting with your primary or referring doctor.

You may need to take antibiotics before the procedure if you:

• Have an artificial heart valve.
• Have ever been told you need to take antibiotics before a dental or surgical procedure.

Do not eat or drink anything for eight hours before the procedure.

You will need to bring a responsible adult to accompany you after the procedure. You should not drive or operate machinery for at least eight hours because the medication given during the procedure may cause drowsiness.

You may need to stay overnight in the hospital after the procedure, so pack personal items you may need.