ERCP stands for Endoscopic Retrograde Cholangio Pancreatography. Endoscopic refers to the process of using a thin, flexible tube-like instrument with a tiny video camera and light (called an endoscope) to inspect the gastrointestinal tract and diagnose specific conditions.
Retrograde refers to the direction that the endoscope is used to inject a liquid that enables X-rays to be taken of the bile duct system and pancreas regions of the GI tract. This X-ray process is also known as cholangiopancreatography (cholangio refers to the bile
duct system and pancrea to the pancreas). ERCP is also useful in helping to diagnose and treat other health issues that cause abdominal pain or jaundice, or a yellowing of the white area around the eyes.
Bile is a substance that the liver produces and is vital to digestion and absorption of fats in the body. It is carried from the liver through a system of tubes known as bile ducts to the gallblader, which stores bile between meals and empties it into the bile duct when food is consumed. The common bile duct is connected to the pancreas by the papilla, which is the main duct from the pancreas. This pathway allows digestive juices from the pancreas to mix with food in the intestine. Problems that affect this region of the GI tract — such as blockage from gallstones, tumors, or stricture — can be diagnosed and corrected with ERCP.
How to Prepare for the ERCP Procedure
Before having an ERCP, there are a number of things you will need to remember:
- Don’t eat or drink anything for at least six hours beforehand or after midnight if your ERCP is scheduled for the following morning.
- Tell your doctor about the medications you are taking, including aspirin-containing drugs and blood thinners.
- Identify any allergies or any reactions you have had to drugs, particularly antibiotics or pain medications.
An ERCP can be done as an outpatient procedure. In some cases it may require hospitalization, depending on your case. Your doctor will explain the procedure and its benefits and risks, and you will be asked to sign an informed consent form. This form verifies that you agree to have the procedure and understand what’s involved.
What Can You Expect During an ERCP?
Your doctors will work hard to make sure that the process is comforting for you. Your blood pressure, pulse, and the oxygen level in your blood will be carefully monitored during the operation. Sedative medications will be given through a vein in your arm.
The endoscope is passed down your throat into your esophagus (the swallowing tube), and through the stomach into your duodenum. The doctor will use it to inspect the lining of your stomach and duodenum. You should not feel any pain.
The instrument is positioned near the papilla and then a small tube known as a cannula is threaded down through the endoscope and can be directed into either the pancreatic or common bile duct. The cannula allows a special liquid contrast
material, a dye, to be injected backwards – that is, retrograde – through the ducts.
X-ray equipment is then used to examine and take pictures of the dye outlining the ducts.
If there is a stone blocking the pancreatic or common bile duct, it is usually possible to remove it. The opening of the papilla would be cut open and enlarged. Then, a special device would be inserted in the region to retrieve the stone.
What are the Possible Complications from ERCP?
ERCP may help you avoid surgery if issues are detected as early as possible. Depending on your case and the types of procedures performed, ERCP typically has a five to ten percent risk of complications. In rare cases, severe complications may require prolonged hospitalization.
After the procedure, there may be a mild to severe inflammation of the pancreas; this is the most common complication and may require hospital care or surgery. Bleeding can occur when the papilla has to be opened to remove stones. This bleeding usually stops on its own, but in some cases, transfusion or endoscopic therapy may be required to control bleeding.
In extreme cases, a puncture or perforation of the bowel wall or bile duct may occur with therapeutic ERCP. This could lead to an infection, especially if the bile duct is blocked and bile cannot be drained. Treatment for infections require antibiotics and restoring drainage.
What Can You Expect After Your ERCP?
You will need to remain under observation until your doctor or healthcare team has decided you can return home. Sometimes, admission to the hospital is necessary. Make sure to arrange for a ride home as you may still be sleepy from the sedatives from the procedure. You should avoid operating machinery for a day and not drink any alcohol.
Because of the air used during ERCP, you may feel full or pass gas more frequently than usual. It is also not aytpical to have soft stool or see brief changes in your bowel movements. However, if you notice any bleeding from your rectum or black, tarry stools, a high fever, or vomiting then it is important that you call your doctor.