What is ERCP?
ERCP is endoscopic retrograde cholangiopancreatography. This endoscopic procedure is used to diagnose and treat disorders of the pancreas, bile duct, liver and gallbladder.
What happens during ERCP?
Your gastroenterologist steers the endoscope, a flexible, thin tube, about as wide as a finger, through your mouth and down into your oesophagus. It is then passed through your stomach and into the duodenum. The end of the endoscope contains a bright light and a tiny digital camera that sends pictures to a large screen so that your consultant can see what is going on.
A very thin tube called a catheter that is less than 2mm wide is then passed down the endoscope until it reaches the point in the small intestine where the bile duct and pancreatic duct drain. This point is called the papilla.
A dye that shows up on X-ray is passed through the catheter and backwards into the bile and pancreatic ducts. An X-ray of your upper abdomen is then taken.
How long does ERCP take?
The examination usually takes about half an hour, but complicated procedures involving treatments may take up to an hour.
Why might you need ERCP?
ERCP can diagnose problems with the bile duct or the pancreatic duct. If all is normal, the dye from the catheter just travels up the ducts, but if there is a gallstone blocking the bile duct or a narrowing in either duct, the dye cannot pass properly and the blockage shows up on the X-ray.
During ERCP, the gastroenterologist may take a biopsy or may place stents (drainage tubes) to relieve any blockage of the ducts.
What should you tell us before ERCP?
Tell your consultant all medications that you take, in particular blood thinners (such as clopidogrel, warfarin, or heparin), which may need to be stopped or adjusted up to a week before the procedure.
Tell us if you have diabetes, as your medication may need adjustment on the day of the procedure.
We will need to know about any allergies, other medical problems, and previous procedures, including pacemakers or hip replacements, as these may influence the techniques used.
How do you prepare for ERCP?
- To allow us a clear view, you should not eat anything for 6 hours before your appointment.
- You may drink clear fluids for up to 2 hours prior to the procedure (allowing you to take prescription medicines if necessary).
- Do not take antacids.
- An oral antibiotic may sometimes be given before the procedure.
What happens on the day you have ERCP?
When you come to the hospital you may be brought to the ward or you might be asked to go directly to the endoscopy unit.
- You will be seen by one of our nursing team, who will ask you a range of further questions about your medical history, medications, and allergies. Since we use X-rays you need to tell us if there is any way you could be pregnant.
- You will need to put on a hospital gown and remove your glasses, contact lenses and dentures.
- A small plastic cannula will be inserted into a vein in your arm or hand.
- Your consultant will discuss again the details of the planned procedure, including alternatives and risks. If you understand and accept what is planned, we will ask you to give your written consent.
- The ERCP examination is performed on an X-ray table.
- Local anaesthetic may be sprayed to numb your throat, and you will be given medications by injection through a vein to make you sleepy and relaxed. Occasionally the procedure is performed with a full general anaesthetic, but this is usually not necessary.
- You will be asked to lie on your left side with your left arm behind you. A guard will be placed to protect your teeth.
- While in this position, the doctor will pass the endoscope through your mouth and down your throat.
- The endoscope will not interfere with your breathing and will not cause any pain.
- The gastroenterologist will use the camera from the endoscope to guide the catheter into place, pass down the dye and take X-rays of your upper abdomen.
What are the risks of ERCP?
ERCP is a generally safe procedure, but any endoscopy carries a risk of complications, such as reactions to medication, perforation of the intestine, and bleeding. The risk of any complication is generally less than 5%, but some indications and interventions during ERCP may increase the risk.
If you are at risk of these potential complications your consultant will discuss them and possible preventive measures with you beforehand. A diclofenac suppository can reduce the risk of pancreatitis, for example.
Complications specific to ERCP include:
- Inflammation of the pancreas (pancreatitis).
- Bleeding (usually if a sphincterotomy, cutting of the sphincter at the lower end of the bile duct, has been performed).
- Duodenal perforation.
- Infection within the bile duct (cholangitis).
These complications usually settle down spontaneously, but you will require a longer hospital stay. Some complications require urgent treatment (very occasionally including surgery).
What happens after ERCP?
Some abdominal discomfort and bloating is common, which usually settles after a few hours.
Your throat may feel numb and slightly sore, and because of the local anaesthetic and sedation you should not attempt to take anything by mouth for at least 1 hour. You will usually be asked not to eat for 4 hours.
If you have received sedation you should be able to leave when fully awake (usually about an hour), but you must be accompanied by a responsible adult. Sedation makes you sleepy but it also affects your judgement and the way you make decisions. If you have been sedated:
- Do not drive home or drive for 24 hours.
- Do not operate machinery.
- Do not make any important decisions.
Many patients having ERCP can go home the same day but you may need to stay overnight. You will be reviewed before going home, to check all is well.
Unwell after your ERCP?
Complications are unlikely but if you experience any of these problems, please seek medical advice and contact us urgently (see below):
- Severe persistent pain.
- Light-headedness or fainting.
- Shivering or fever.
- Vomiting of blood.
- Passing of blood or black tar-like stools.
Getting more information
If you have any questions concerning your procedure, please contact the gastroenterology/hepatology team at The Physicians' Clinic
The team is available Mon – Fri 0900-1700
Tel: 020 7034 8164
Fax: 020 7034 8140
￼￼￼￼If you experience problems:
- Contact your consultant directly by telephoning The Physicians' Clinic during office hours as above.
- Out of hours, please contact your gastroenterologist directly using the information supplied after your appointment.