What is Endoscopic retrograde cholangiopancreatography (ERCP)?
Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to treat problems of the bile and pancreatic ducts. A special side viewing endoscope (camera) is utilized to visualize the opening (called the ampulla) to the bile duct and pancreas and access the bile duct (the tube draining bile from the liver and gall bladder) or the pancreatic duct (the tube draining pancreatic juices from the pancreas).
Why do I need an ERCP?
An ERCP allows the gastroenterologist to visualize the bile ducts or the pancreatic ducts under fluoroscopy (X ray views using contrast). It is a combination of two techniques, endoscopy and fluoroscopy. The endoscope allows the physician to view the opening of the bile and pancreatic ducts (channels) and access the them using a thin catheter. The catheter is then used to fill the ducts with contrast and view them under X ray visualization. This allows the gastroenterologist to diagnose and treat conditions of the bile ducts and pancreatic ducts.
ERCP may be used before or after gallbladder surgery to detect stones in the bile duct or bile leaks as well as treat blockages of the bile or pancreatic ducts. Bile duct stones can be diagnosed and removed with an ERCP. Any narrowing (called stricture) or blockages of the bile ducts can be diagnosed using ERCP and treated with stent (a plastic or metallic tube) placements.
In patients with suspected or known pancreatic disease, ERCP can help determine the need for surgery and pancreatic stones can be removed by ERCP, if needed.
I already had an MRCP scan. How is the ERCP going to add anything more?
MRCP stands for Magnetic Resonance Cholangio-Pancreatography. MRCP consists of creating a magnetic resonance field generated by an MRI machine around the patient that then takes images from multiple angles which are then used to recreate the images of the bile duct using computer aided techniques, without using any contrast. MRCP is non-invasive, usually does not pose any risks to the patient and is therefore, preferred to ERCP for diagnostic purposes.
If MRCP findings are unclear, if there is persistent suspicion for a clinical condition or any therapy is indicated/recommended based on the results of the MRCP or EUS, an ERCP is offered to the patient.
Some patients are claustrophobic and may choose to undergo ERCP to evaluate abnormal findings found on other modalities.
Are there any risks of having an ERCP?
ERCP is a highly specialized procedure which requires a lot of experience and skill. The procedure is quite safe and is associated with a very low risk when it is performed by experienced physicians. The success rate in performing this procedure varies from 70% to 95% depending on the experience of the physician. Complications can occur in approximately one to five percent depending on the skill of the physician and the underlying disorder. The most common complication is pancreatitis (can occur in up to 5% of cases based on cumulative data) which is due to irritation of the opening to the pancreas from the technique or the injection of dye used to take pictures and can occur even with very experienced physicians. Another possible complication is bleeding (can occur in up to 2% of cases based on cumulative data). Other serious risks including infections (up to 1% depending on the disease being treated), perforation of the intestine (<1%), and drug reactions (rare).
In older or sicker patients, depressed breathing, irregular heartbeats, heart attacks and even deaths have been described but are extremely rare and is mainly due to additive risks of anesthesia to their health problems.
In case of complications, patients usually need to be hospitalized, but surgery rarely is required.
What do I have to do to prepare for the ERCP procedure?
Your stomach should be empty to allow an effective and safe examination. You should not eat or drink anything, including water, for about 8 hours prior to your endoscopy (we will usually ask that you fast from midnight onwards on the day of your procedure).
Most medications can be continued prior to the exam but some medications such as aspirin or blood thinners may need to be stopped and we will give you instructions based on your individual circumstance. We encourage you to ask the physician specifically about these medications.
If you are diabetic, you will need to monitor your blood glucose carefully on the day prior to your procedure. We will give you specific instructions, if you are on insulin or take oral hypoglycemic agents like Glyburide or any of the newer drugs. We will try and schedule your procedure(s) early in the morning on the planned date.
Occasionally, we may ask you to get clearance from your cardiologist or another specialist for the procedure, usually from an anesthesia perspective.
What happens on the day of my procedure?
We will ask you to come an hour prior to your scheduled time to register and be admitted to our endoscopy unit (we do procedures at the hospital or at the ambulatory surgical center). The nursing staff will help you change into a comfortable gown and place you on a stretcher. An IV line will be placed to help us give you fluids and medications for the procedure. You will be asked to complete a health questionnaire, confirm your consent for the procedure and may meet a member of the anesthesia staff. Once the documentation and safety checks have been completed, you will be taken to the procedure room. You will then be given anesthesia or moderate sedation and go off to sleep. Once the procedure is completed, you will wake up and usually experience no pain or discomfort. Occasionally, people may complain of a sore throat or more significantly, abdominal pain. If this happens, we may admit you for observation and/or treatment, as indicated.
You will be taken to the recovery area and be monitored for about 30-60 mins prior to being discharged home.
You will need to have a driver pick you up from the unit and drive you home. Ideally, there should be someone with you at home to supervise your recovery as you may experience some drowsiness or groggy feeling as the sedative/anesthetic agent works its way out of your body.
Important:
1. We strongly urge you to not drive on the day of your procedure as your reflexes may be slower that you anticipate.
2. For safety reasons, you cannot use a taxi or public transportation to go home.
3. We strongly urge you to defer planning or making any legal decisions for up to 24 hours after the procedure, to ensure that your mind is clear and unaffected from the residual effects of anesthesia or moderate sedation.
4. We recommend not making any travel plans for up to a week after your procedure. This varies greatly – please discuss any planned or upcoming travel with Dr. Siddique at the time of scheduling.
5.If we need to admit you for observation due to concerns about a possible complication, we will speak to you in recovery. If you develop any symptoms later in the day, please contact the on-call doctor (usually Dr. Siddique) or return to the ER at the same hospital, where you had your procedure. We apologize in advance for any inconvenience due to this - our primary priority is your safety and well-being.
