ERCP

PREPARATION
HOW IS IT DONE?
AFTER THE PROCEDURE
QUESTIONS OR PROBLEMS
ERCP TREATMENTS
RISKS
 

ERCP (endoscopic retrograde cholangiopancreatography) is used in the diagnosis and treatment of disorders of the pancreas, bile duct, liver and gallbladder. The doctor passes an endoscope (a thin, flexible fiberoptic scope), through your mouth past the esophagus and stomach into the beginning portion of the small intestine/duodenum. The doctor then injects contrast dye into an opening in the small bowel (major or minor ampulla) which leads into the bile ducts or pancreatic duct, in order to take detailed x-ray pictures or to perform therapeutic maneuvers.

Since x-rays are taken you should inform us if there is a possibility of pregnancy.

 

 

Preparation

When your procedure is scheduled, you will be given specific instruction for preparing for your exam.  The prep instructions vary, depending on the time of your appointment as well as other factors.  If you have any questions regarding your prep, contact our office at 541 868-9500.  Urgent concerns outside of the office hours should be directed to the on-call physician at 541 868-9500 (toll free 877 484-4501).

How is it done?

The doctor and/or nurse will explain the procedure and answer your questions. If you have any questions be sure to ask. Please tell us if you have had any other endoscopic examinations or any allergies or bad reactions to medications or contrast dye. You will be asked to sign a consent form giving your permission for the procedure. You will need to put on a hospital gown and remove eyeglasses, contact lens and dentures.

The examination is performed on an x-ray table. Local anesthetic may be sprayed in your mouth to make it numb, and you will be given medication by injection through a vein to make you sleepy and relaxed. You will also receive intravenous antibiotics to prevent potential infection from the procedure While in the prone position the doctor will pass the endoscope through your mouth and down your throat. A dental guard will be placed to protect your teeth. The endoscope will not interfere with your breathing and will not cause any pain. You may be asked to change positions during the examination, assisted by a nurse. The examination usually takes from 30 to 90 minutes.

After the procedure

Your throat may feel numb and slightly sore. Because of the local anesthetic and sedation you should not attempt to take anything by mouth for at least one hour. It is wise to take only clear liquids for the rest of the day. If you are an outpatient you will remain in the short stay unit for at least 2 to 3 hours following the procedure. A companion must be available to drive you home, as the sedation impairs your reflexes and judgment. For the remainder of the day you should not drive a car, operate machinery or make any important decisions. We suggest that you rest quietly.

Questions or problems

We have a doctor on call 24-hours a day and he/she may be contacted by phoning 541 868-9500 (or toll free 877 484-4501). The emergency room is also an option for more serious problems.

ERCP Treatments

  • Sphincterotomy: If the x-ray shows a gallstone or other blockage, the doctor can enlarge the opening of the bile duct by making an incision using cautery. This is called a sphincterotomy and is done with an electrically heated wire (which you will not feel). Any stones will be collected into a tiny basket or left to pass into the intestine.
  • Stenting: A stent is a small plastic tube which is pushed through the endoscope and into the narrowed area of the bile duct. This relieves the jaundice by allowing the bile to drain freely into the intestines. Stents are also sometimes placed into the pancreatic duct when it is narrowed or blocked.
  • Nasobiliary tube: Sometimes a small plastic tube is left in the bile duct and brought out through the nose. This tube may be left in place for a few days. This helps the drainage of bile and allows for further x-rays to be taken to check when the duct is clear. The presence of the tube may be slightly uncomfortable at first, but does not interfere with eating or drinking.
  • Rendezvous procedure/transhepatic cholangiogram: For a variety of reasons it is sometimes necessary to request a radiologist (a specialist in x-rays), to perform a transhepatic cholangiogram in conjunction with an ERCP. This procedure involves passing a thin needle through the abdomen into the bile ducts, allowing the placement of drainage catheters, guide wires, etc. At times this can be very useful in difficult cases to make it easier to perform a sphincterotomy, place a stent, perform a dilatation or other procedure. Frequently the decision whether this procedure will be necessary cannot be made until the patient is sedated while the ERCP is being performed.

Risks

Endoscopy can result in complications such as reactions to medications, perforation of the intestine and bleeding. Injection of contrast dye through the endoscope into the pancreatic duct or bile duct can cause an allergic reaction, inflammation of the pancreas (pancreatitis), and infection of the bile duct (cholangitis). These complications are infrequent but may require urgent treatment, even surgery. Be sure to inform us if you have any pain, fever or vomiting in the 24 hours after ERCP.

These treatments for stones and blockages have been developed and are recommended to you because they are simpler and safer than standard surgical operations. However, you should realize that they are not always successful and problems can arise. Potential complications include perforation of the intestine, bleeding, inflammation of the pancreas (pancreatitis), and infectionof the bile duct (cholangitis). These complications are infrequent but may be serious enough to require urgent treatment and even surgery.

It is very unusual for other biliary problems to develop in the months or years after sphincterotomy, but jaundice, fevers and even new stones can infrequently occur. Usually these can be dealt with by a repeat endoscopic procedure.

 

Note: The information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

BACK TO TOP
BACK TO PROCEDURE LIST