Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized technique used to study the bile ducts, pancreatic duct and gallbladder. Ducts are drainage routes. The drainage channels from the liver are called bile or biliary ducts while the pancreatic duct is the drainage channel from the pancreas.

How is ERCP performed?
During ERCP, your doctor will pass an endoscope through your mouth, esophagus and stomach into the duodenum (first part of the small intestine). An endoscope is a thin, flexible tube that lets your doctor see inside your bowels. After your doctor sees the common opening to the ducts from the liver and pancreas, called the major duodenal papilla, your doctor will pass a narrow plastic tube called a catheter through the endoscope and into the ducts. Your doctor will inject a contrast material (dye) into the pancreatic or biliary ducts and will take X-rays.

How should I prepare for the procedure?
An empty stomach is essential for an accurate and safe examination, so you should have nothing to eat or drink, including water, for at least eight hours before the examination.

Can I take my current medications?
Most medications can be continued as usual.  Inform us about medications you’re taking, particularly aspirin products, arthritis medications, anticoagulants (blood thinners), insulin or iron products.

What about Aspirin?
Aspirin should be discontinued for 5 days prior to ERCP.

What about Plavix® (clopidogrel)?
Plavix® (clopidogrel) should be discontinued for 5 days prior to ERCP.

What about Pradaxa® (dabigatran)?
Please stop taking Pradaxa® (dabigatran) 36 hours before your test.  Pradaxa® (dabigatran) has an extremely short half-life, unlike Coumadin®, which means the blood thinning effect is gone after 24-36 hours after stopping the medication.

What about Coumadin®?
Your physician will discuss holding Coumadin® with you prior to scheduling your procedure.

What if I use inhalers for asthma or other breathing problems?
Please use your inhalers as you would normally use them.  Also, please be sure and bring all of your inhalers to your procedure, as you may be asked to use them just prior to your exam.

Will I need antibiotics?
Possibly.  This will depend on the specific circumstances of why you are having the ERCP done.  Your physician will discuss antibiotics with you prior to scheduling your procedure.

What can I expect during ERCP?
You will be given a sedative, propofol, by our anesthesia team who will be present to monitor your vital signs during the examination.  You will not experience any sensation of gagging or choking. A mouthpiece will be placed between your teeth to keep your mouth open and to prevent your teeth from biting our scope.  Some patients also receive antibiotics before the procedure. You will lie on your abdomen on an X-ray table. The instrument does not interfere with breathing, but you might feel a bloating sensation because of the air introduced through the instrument.

What are possible complications of ERCP?
ERCP is a well-tolerated procedure when performed by doctors who are specially trained and experienced in the technique. Although complications requiring hospitalization can occur, they are uncommon. Complications can include pancreatitis (inflammation of the pancreas), infections, bowel perforation and bleeding. Some patients can have an adverse reaction to the sedative used. Sometimes the procedure cannot be completed for technical reasons.

Risks vary, depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems. Patients undergoing therapeutic ERCP, such as for stone removal, face a higher risk of complications than patients undergoing diagnostic ERCP. Your doctor will discuss your likelihood of complications before you undergo the test.

At Gastroenterology Consultants we offer endoscopic ultrasound (EUS), which can often obtain information previously only available by ERCP.  This can preempt the need for ERCP when negative findings are noted, thus saving you from the higher risk unnecessary ERCP.  If positive findings are noted and an ERCP is required, the risk can be better stratified and sometimes the procedure can be done in the same visit.

What can I expect after ERCP?
You will be monitored until most of the effects of the medication have worn off. Your throat might be a little sore, and you might feel bloated because of air introduced into your stomach during the test. You will be given a liquid to drink before you leave our office. Once you leave the office, you will be able to eat unless you are instructed otherwise.

The results of the examination will be discussed with you. If a biopsy or brushing was taken, the material is sent to a pathology lab and the results are available in approximately 5 business days. Your results will be given to you directly at a follow-up appointment or you will receive a letter via standard mail delivery with the results and recommendations for follow-up.  All of the results, including your pathology results and procedure reports will be forwarded to your primary care physician and the physician that referred you to Gastroenterology Consultants.

You will not be allowed to drive for 12 hours. You will need to arrange for someone to accompany you home because the sedatives might affect your judgment and reflexes for the rest of the day.