ERCP is short for…Endoscopic Retrograde Cholangio Pancreatography
Endoscopic refers to the use of an instrument called an endoscope - a thin, flexible tube with a tiny video camera and light on the end. The endoscope is used by a highly trained subspecialist, the gastroenterologist, to diagnose and treat various problems of the GI tract. The GI tract includes the stomach, intestine, and other parts of the body that are connected to the intestine, such as the liver, pancreas, and gallbladder.
Retrograde refers to the direction in which the endoscope is used to inject a liquid enabling X-rays to be taken of the parts of the GI tract called the bile duct system and pancreas.
The process of taking these X-rays is known as cholangiopancreatography. Cholangio refers to the bile duct system, pancrea to the pancreas.
ERCP may be useful in diagnosing and treating problems causing jaundice (a yellowing of the whites of the eyes) or pain in the abdomen. To understand how ERCP can help, it’s important to know more about the pancreas and the bile duct system.
Bile is a substance made by the liver that is important in the digestion and absorption of fats. Bile is carried from the liver by a system of tubes known as bile ducts. One of these, the cystic duct, connects the gallbladder to the main bile duct. The gallbladder stores the bile between meals and empties back into the bile duct when food is consumed. The common bile duct then empties into a part of the small intestine called the duodenum. The common bile duct enters the duodenum through a nipple-like structure called the papilla.
Joining the common bile duct to pass through the papilla 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 the pancreas and bile duct system can, in many cases, be diagnosed and corrected with ERCP.
For example, ERCP can be helpful when there is a blockage of the bile ducts by gallstones, tumors, scarring or other conditions that cause obstruction or narrowing (stricture) of the ducts. Similarly, blockage of the pancreatic ducts from stones, tumors, or stricture can also be evaluated or treated by ERCP, which is useful in assessing causes of pancreatitis (inflammation of the pancreas).
Problems with the bile ducts or pancreas may first show up as jaundice or pain in the abdomen, although not always. Also, there may be changes in blood tests that show abnormalities of the liver or pancreas.
Other special exams that take pictures using X-rays or sound waves may provide important information for use along with that obtained from ERCP.
Before the Procedure
Regardless of why ERCP has been recommended for you, there are important steps you can take to prepare for and participate in the procedure.
In addition to changes to your medication, you'll also need to:
Tell the doctor if you have: a pacemaker, a joint replacement, heart, lung or other medical conditions that may need special attention .
Tell your doctor if you have to take antibiotics before dental treatment. If so, you may also need antibiotics before an upper endoscopy
Because you will receive a relaxing medication during your procedure, you must arrange to have a responsible adult pick you up and/or accompany you home if you taking public transportation. You may not operate an automobile or other mechanical equipment until the day following your procedure.
Preparation for the Procedure
You must not eat or drink anything for at least six hours before the procedure. Ideally you must not eat or drink anything after midnight the night before your procedure. Food in the stomach will block the view through the endoscope and it could cause vomiting. ERCP can be done either as an outpatient procedure or may require hospitalization, depending on the individual case. The exception is medication taken with small sips of water.
During the Procedure
Risks of this Procedure
Thanks to ERCP, these kinds of procedures may help you avoid surgery. Depending on the individual and the types of procedures performed, ERCP does have a five to ten percent risk of complications. In rare cases, severe complications may require prolonged hospitalization.
Mild to severe inflammation of the pancreas is the most common complication and may require hospital care, even surgery. Bleeding can occur when the papilla has to be opened to remove stones or put in stents. This bleeding usually stops on its own, but occasionally, transfusion may be required or the bleeding may be directly controlled with endoscopic therapy.
A puncture or perforation of the bowel wall or bile duct is a rare problem that can occur with therapeutic ERCP. Infection can also result, especially if the bile duct is blocked and bile cannot drain. Treatment for infection requires antibiotics and restoring drainage. Finally, reactions may occur to any of the medications used during ERCP, but fortunately these are usually minor.
Be sure to discuss any specific concerns you may have about the procedure with your doctor.
After the Procedure
When your ERCP is completed you will be cared for in a recovery area until most of the effects of the medication have worn off.
When your ERCP is completed on an outpatient basis, 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.
Your doctor will tell you when you can take fluids and meals. Usually, it is within a few hours after the procedure.
Tell your doctor immediately if you:
Your doctor will explain the results of the examination to you or arrange for you to come back to hospital and talk to you about the results.