Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized endoscopic technique used to study the gallbladder, pancreas and bile ducts, and has the added benefit of being a therapeutic tool. ERCP has been in use for more than 40 years, and is considered the standard modality for diagnosing and treating disorders of the biliary tract.

During ERCP, patients first receive an anesthetic to numb the throat, along with a sedative. Your gastroenterologist will then pass a flexible endoscope with a miniature TV camera through your mouth and into the stomach and small intestine. When your gastroenterologist sees the opening of the bile and pancreatic ducts on the monitor, he or she then passes a catheter (a narrow plastic tube) containing a contrast dye through the endoscope. The dye is injected into the biliary and pancreatic ducts and X-rays are taken and viewed on a computer monitor. The procedure takes 60 to 90 minutes and is performed in Virginia Mason's Section of Gastroenterology and Hepatology.   Q&A: Endoscopes and ERCP

What preparations are required?
You will be given written instructions for the endoscopy (ERCP and EUS prep planner) that will include diet and other information. Please review this prep planner in advance, follow the instructions closely and call if you have any questions. You must not eat or drink anything for the six hours prior to this exam.

You must arrange someone to drive you home after your procedure otherwise the procedure will be canceled. For more information, view the ERCP and EUS preparation planner.

Can I take my current medications?
Please contact your regular doctor if you are on a blood thinner such as Coumadin, Warfarin or Plavix. Contact your doctor if you are a diabetic and need to give yourself insulin; do not take any diabetic pills on the day of your procedure. You may take all your other regular medications with a small amount of water. Please bring a detailed list of your regular medications with you on the day of your exam.

What happens during an ERCP?
You will have a chance to meet with the doctor in the procedure room. He/she will discuss your concerns and explain the risks and benefits of the procedure. The doctor will then inject some sedation medication into your vein. This medication is given to relax you and allow you to rest during the exam. Most people get sleepy, drowsy, relaxed and forgetful, but you will not become unconscious. You may have a brief sensation of pressure in the back of your throat. If you are uncomfortable during the procedure, you can be given more medication if it is safe to do so. The nurse will constantly monitor you and give you medication as you need it. The procedure takes about 60-90 minutes.

What happens after an ERCP?
You will spend at least 30 minutes in our recovery room and be allowed to rest. The nurses will monitor you while you are in recovery. You will be transferred to the  hospital  if you must stay overnight. If you will be discharged and allowed to go home, you will be able to get dressed and leave after you are awake. Even though you feel awake and alert after you leave the clinic, your judgment and reflexes will be impaired for the rest of the day. That is why you must have someone to drive or take you home and it is recommended that someone stay with you for the next several hours. It is preferred that you have a clear liquid diet for the next 24 hours. You will be able to return to normal activities the next day, unless your doctor gives you other instructions.

What if the ERCP shows something?
If your doctor sees any area that needs further evaluation, he/she will pass an instrument through the endoscope to take a biopsy, or brushing (a small sample of the  lining). This tissue will be sent to the lab to be analyzed. Taking a small biopsy will not cause you pain or discomfort. You will be notified of the lab results in about 10 days.

If a stent (small plastic tube) is placed, you will be instructed when to have this checked or removed. If a stone is removed from the bile or pancreatic duct following an internal incision, overnight hospitalization is often recommended.

Will I talk with the physician after the procedure?
Not necessarily. Your physician will write his/her findings and special instructions on  the post-procedure instruction sheet, and a nurse will go over all the findings and instructions with you. You will be provided with the phone numbers to call should you have additional questions.

What are the possible complications of ERCP?
ERCP is generally safe procedure. The most common complication is inflammation of the pancreas (pancreatitis) which can occur in 5 percent of patients and may be associated with abdominal pain, nausea and vomiting, and need for hospitalization. One possible complication is a perforation, or tear, through the bowel wall that could require surgery or stent placement. Bleeding might occur at the site of biopsy or internal incision but it's usually minor. Bleeding can stop on its own or be controlled through the endoscope; it rarely requires follow-up treatment. Some patients might have a reaction to sedative or complication from heart or lung disease.

What if I have other questions or concerns?
Our staff and nurses are available Monday through Friday from 8:30 a.m. to 4:30 p.m. They can be reached at (206) 223-2319.