What is ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is a medical procedure that links upper gastrointestinal (GI) endoscopy and x-rays to treat problems of the bile and pancreatic ducts.

What are the bile and pancreatic ducts?

Bile ducts are tubes that carry bile from the liver to gallbladder and duodenum. Pancreatic ducts are tubes that carry pancreatic juice from the pancreas to duodenum. The small pancreatic duct empties itself into the main pancreatic duct. Common bile duct and main pancreatic duct join before emptying into the duodenum.

Why do doctors use ERCP?

The medical professional uses ERCP to treat problems of the bile and pancreatic ducts. Only for diagnosis, doctors can use non-invasive tests-tests that do not physically enter the body-instead of ERCP.

Non-invasive tests like magnetic resonance cholangiopancreatography (MRCP)-types of magnetic resonance imaging (MRI) -are safer and can also diagnose many problems of the bile and pancreatic ducts.

Doctors perform ERCP when the patient's bile or pancreatic ducts have become narrowed or blocked because of

• Gallstones that form in gallbladder and become stuck in the common bile duct
• Infection
• Acute pancreatitis - Acute pancreatitis is a sudden inflammation that lasts for a short time.
• Chronic pancreatitis - Chronic pancreatitis is an inflammation of the pancreas that doesn't improve over time.
• Trauma or surgical complications in the bile or pancreatic ducts
• Pancreatic pseudocysts
• Tumors or cancers of the bile ducts
• Tumors or cancers of the pancreas

Inform the doctor

The patient should inform the doctor about any allergies, medical conditions that he is having and all the prescribed over-the-counter medicines, vitamins, and supplements he takes including

• arthritis medicines
• aspirin or medicines that contain aspirin
• blood thinners
• blood pressure medicines
• diabetes medicines
• non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen

The doctor may ask the patient to temporarily stop taking medicines that affect blood clotting or intake of sedatives. The patient typically consumes sedatives during ERCP to help him relax and stay comfortable.

If the patient is pregnant and needs ERCP to treat a problem, the doctor performing the procedure may make changes to protect the fetus from x-rays. It has found that ERCP is generally safe during pregnancy.

How do doctors perform ERCP?

The medical professionals who have specialized training in ERCP perform this procedure at a hospital or an outpatient center. An intravenous (IV) needle will be placed in the patient's arm to introduce a sedative.

The patient will be asked to lie on an examination table. The doctor will carefully feed the endoscope down the esophagus, through the stomach, and into the duodenum. A small camera which is mounted on the endoscope will send a video image to the monitor. The endoscope pumps air into the patient's stomach and duodenum, making them easier to see.

During ERCP, the doctor

• locates the opening where the bile and pancreatic ducts empty into the duodenum
• slides a thin, flexible tube called a catheter through the endoscope and into the ducts
• inserts a special dye, also called contrast medium, into the ducts through the catheter to make the ducts more visible under x-rays
• further uses a type of x-ray imaging, called fluoroscopy to examine the ducts and look for narrowed areas or blockages

The procedure most often takes between 1 and 2 hours.

What should the patient expect after ERCP?

After ERCP, the patient can expect the following:

• The patient may have bloating or nausea for a short time after the procedure.
• The patient may have a sore throat for 1 to 2 days.
• The patient can go back to a normal diet once his swallowing has returned to normal.
• The patient should rest at home for the remainder of the day.

Some results from ERCP are available immediately after the procedure. After the sedative has worn off, the doctor will share results with the patient and their friend or family member.

If the doctor performed a biopsy, a pathologist will examine the biopsy tissue. Biopsy results take a few days or longer to come back.

What are the risks of ERCP?

The risks of ERCP include complications such as the following:

• pancreatitis
• infection of the bile ducts or gallbladder
• excessive bleeding, called hemorrhage
• tissue damage from x-ray exposure
• death, although this complication is rare