General Information
ERCP is a sophisticated study of the bile ducts and the pancreas. This study is the gold standard for evaluation of biliary and pancreatic abnormalities. ERCP is performed to remove gallstones in the common bile duct, evaluate the pancreas and treat gallstone pancreatitis.
Indications
There are many reasons for an ERCP to be performed. Common reasons for an ERCP to be performed include diagnosis and treatment of disorders of the bile ducts such as Primary Sclerosing Cholangitis and remove stones from the common bile duct. The pancreas can also be evaluated during the procedure. Common reasons for pancreatic disorders include pancreatic stones, strictures (narrowing) of the pancreatic duct, chronic pancreatitis and pancreas divisum.
Alternatives to ERCP
Other methods used to evaluate the biliary duct are CT scans, Ultrasound and MRI cholangiography (MRC). Other less commonly used tests include a HIDA scan and percutaneous transhepatic cholangiography. These tests may be done prior or after an ERCP in order to provide additional information to your physician.
The complications of ERCP are:
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Perforation |
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Allergic Reaction to medications. |
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Bleeding |
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Infection |
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Pancreatitis (approximately 3%) |
You should discuss your medication with your physician prior to the procedure. Usually, medications are not taken the morning of the procedure. However, some medications should be taken if the procedure is to be done later in the afternoon. Adjustments in your insulin dose should also be discussed with the physician.
You should not eat or drink any food or liquids, unless approved by your physician, for approximately 12 hours before the procedure. No other special preparations are required. Depending upon your individual medical problems, you may require antibiotics before the procedure. If you have a history heart problems involving the valves of the heart or have had antibiotics before dental work, please inform your physician well in advance. This will allow the hospital staff time to prepare and administer these medications.
The Procedure
Patients undergoing this procedure usually receive a combination of intravenous anesthetics. These are usually Demerol (meperidine), Versed (midazolam) or Fentanyl. The exact combination, dose and frequency of each of these are individualized for each patient. In most cases, patients do not remember their procedure, or, are adequately sedated such that the discomfort is well tolerated.
After you arrive at the hospital, an IV will be placed. You will be evaluated by the hospital nursing staff at that time. Your blood pressure, heart rate etc. will be taken and recorded. A heart monitor and supplemental oxygen may also be arranged at that time.
You will be taken to the radiology suite and placed on your stomach. After your physician arrives, you will be given intravenous medications to produce a state of conscious sedation. Once you are sedated, an endoscope (a fiber optic instrument) will be passed through your mouth and into the stomach. The endoscope will then be passed into the small intestine. Through the inside of the scope special instruments will be passed so that the bile ducts and pancreatic duct can be evaluated. X-ray images will be taken during the procedure. Depending upon the findings from the x-rays, your physician will then treat the underlying condition.
After the Procedure (Post-op)
You will be taken to the recovery room where your blood pressure, heart rate, oxygen saturation, etc. will continue to be monitored by the nursing staff.
Many patients undergoing an ERCP receive large amounts of sedation for the procedure. Sometimes, patients are kept over night in the hospital to insure that the sedatives have completely worn off.
Patients must have someone to drive him or her home after conscious sedation (analgesics) have been administered.
Most patients will be lethargic and forgetful during the afternoon after the procedure. During this period of time, someone should be available to check in the with patient ensure their safety. No driving, complicated or important decisions or alcoholic beverages are allowed on the day of the procedure. By the next morning, most patients are able to continue with their daily activities.
To assist our patients, a written explanation of the procedure and its findings, in lay terms, will be given to the patient. Recommendations will be made regarding any further testing, treatments or office visits.
A copy of the endoscopic record is sent to all our referring physicians. Thus, your primary care physician will be aware of your procedure, the results and your gastroenterologist's recommendations.
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