Endoscopic Retrograde Cholangiopancreatography (ERCP)
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What is an ERCP?  
ERCP is a specialized technique used to study the ducts (drainage routes) of the liver, gallbladder, and pancreas (the drainage channels from the liver are called bile ducts or biliary ducts).  When performed by physicians with special training in this procedure, ERCP can be accomplished in 90-95% of patients.  ERCP is a valuable tool that is used for diagnosis and treatment of many diseases of the pancreas, bile ducts, liver, and gallbladder.  Structural abnormalities such as gallstones, tumors, or strictures (obstructing scar tissue) can be shown in detail and biopsies of abnormal tissue can be obtained if necessary.  Several conditions of the biliary or pancreatic ducts can be treated (cured or improved) by therapeutic ERCP techniques that can open the end of the bile duct, remove stones, and place stents (plastic drainage tubes) across obstructed ducts to improve their drainage.

What should I expect during an ERCP?   
Plan to spend up to three hours at the hospital the day of your ERCP. The exam itself takes approximately 30 to 90 minutes to complete.  Before the exam, you will be asked about your medical history, and a nurse will insert an intravenous (IV) line into your hand or arm.
During the exam, you will be given medicine through the IV line to help you relax.  In certain situations, you may receive general anesthesia. You will lie on your left side, and your heart rate and oxygen levels will be monitored continuously.  Some patients also receive antibiotics before the procedure.  The doctor will insert a flexible, hollow tube – called an endoscope – into your mouth and will advance it slowly through the esophagus, stomach and duodenum (the first part of your small intestine).  The instrument does not interfere with breathing.  Air is introduced through the instrument and may cause temporary bloating during and after the procedure.  After the opening to the ducts is visually identified, a catheter (narrow plastic tube) is passed through the endoscope into the ducts.  Contrast material ("dye") is then injected gently into the ducts (pancreatic or biliary) and x-rays are taken.    The injection of contrast into the ducts or removal of a stone may occasionally cause discomfort.

What should I expect after an ERCP?  
The doctor will prepare a full report for the physician who referred you for the ERCP.  If you are having an ERCP as an outpatient, you will be kept under observation until most of the effects of the medications have worn off.  If you have been given medications during the procedure you will not be allowed to drive, take a taxi, or ride the bus.  A responsible adult must drive and accompany you home from the procedure because of the sedation used during the examination.  Evidence of any complications of the procedure will be looked for and hospitalization may be advised if further observation is necessary. Your throat may feel sore for a short time.  You may feel bloated after the procedure. This is normal.  On discharge, you will receive specific instruction on when to resume your usual diet and medications.

What are possible complications of ERCP? 
ERCP is generally a well-tolerated procedure when performed by physicians who have had special training and experience in this technique.  However all procedures carry some risk.  In ERCP, intravenous (IV) sedation is used, and localized irritation of the vein into which medications were given may cause a tender lump that may last days to weeks. The application of heat packs or hot moist towels to the area may ease the discomfort.  An adverse reaction to the sedative may occur, including allergic reactions and changes in breathing, blood pressure, and heart rate.

Additional complications specific to ERCP can occur, including pancreatitis, infection, bowel perforation (a small hole in the digestive tact), and bleeding.  The risks of the procedure vary with the indications for the test, what is found during the procedure, what therapeutic intervention is undertaken, and the presence of other major medical problems, such as heart or lung diseases.  Published studies show the risk of pancreatitis is 5-10%, and the risk of infection, bleeding, and perforation are all less than 1%.  If a complication does occur, it may result in hospitalization, blood transfusion, repeat procedure, or occasionally corrective surgery.  Your physician will discuss the likelihood of complications with you before undergoing the test.