Digestive Diseases and ERCP Testing

ERCP (short for endoscopic retrograde cholangiopancreatography) is a procedure used to diagnose diseases of the gallbladder, biliary system, pancreas, and liver. The test looks "upstream" where digestive fluid comes from -- the liver, gallbladder, and pancreas -- to where it enters the intestines. In addition, ERCP can be used to treat problems in these parts of the digestive system.

What Happens During ERCP?

During an ERCP, a gastroenterologist (doctor who specializes in treating diseases of the gastrointestinal system), uses a special endoscope (a long, flexible tube with a light and camera at the end) to examine the inside of the digestive system. The doctor identifies the place where the bile duct comes into the intestine and then feeds a tiny catheter (a plastic tube) into the duct and squirts in a contrast agent while X-rays are taken. The contrast agent allows the doctors to see the bile ducts, the gallbladder, and the pancreatic duct on the X-rays.

Once the source of the problem is identified, the doctor may then treat it by performing one of the following procedures.

• Sphincterotomy. This involves making a small incision (cut) in the opening of the pancreatic duct or the bile duct, which can help small gallstones, bile, and pancreatic juice to drain appropriately.
• Stent placement. A stent is a drainage tube that is placed in the bile duct or the pancreatic duct to hold the duct open and allow it to drain.
• Gallstone(s) removal. ERCP can remove gallstones from the bile duct, but not from the gallbladder itself.

Is An ERCP Safe?

An ERCP is considered a low-risk procedure; however, complications can occur. These can include pancreatitis, infections, bowel perforation, and bleeding. Patients undergoing an ERCP for treatment, such as for gallstone removal, face a higher risk of complications than patients undergoing the test to diagnose a problem. Your doctor will discuss the risks of possible complications before the test.

How Should I Prepare for ERCP?

Before having ERCP, let your doctor know about any special medical conditions you have, including:

• Pregnancy.
• Lung conditions.
• Heart conditions.
• Allergies to any medications.

If you have diabetes and use insulin. You may need to adjust the dosage of insulin the day of the test. Your diabetes care provider will help you with this adjustment. Bring your diabetes medication with you so you can take it after the procedure.

If you are taking blood-thinning medications such as aspirin, clopidogrel (Plavix), dipyridamole (Persantine), enoxaparin (Lovenox), or warfarin (Coumadin), your primary doctor may ask you to hold these medications or prescribe an alternate method for thinning your blood before the procedure.

Do not discontinue any medication without first consulting with your primary or referring doctor.

Do not eat or drink anything for eight hours before the procedure.

You may be drowsy for some time after sedation, so you should ask for help from a responsible adult who can take you home after the procedure. You should not drive or operate machinery for at least eight hours because the medication given during the procedure may cause drowsiness.

You may need to stay overnight in the hospital after the procedure, so pack personal items you may need.

What Happens After ERCP?

You will stay in a recovery room for about 1-2 hours for observation. You may feel a temporary soreness in your throat. Suck on throat lozenges to relieve the pain.

A responsible adult must take you home after the procedure. It is also recommended that someone stay with you for 24 hours after the procedure.

Do not drive or operate machinery for at least eight hours.

Stay overnight within a 30-minute drive of the hospital so you can get to the emergency room quickly to be evaluated, if necessary.

The results will be sent to your primary or referring doctor, who will discuss them with you. If the results of the procedure indicate that prompt medical attention is needed, the necessary arrangements will be made and your referring doctor will be notified.

Warning About ERCP

If you have any of the following symptoms within 72 hours after ERCP, call your doctor and seek emergency care:

• Severe abdominal pain
• A continuous cough
• Fever
• Chills
• Chest pain
• Nausea or vomiting
• Bleeding or vomiting blood
• Blood in your stool

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