ERCP (short for endoscopic retrograde cholangiopancreatography) is a procedure used to diagnose
diseases of the gallbladder, bile system, pancreas, and liver.
What happens during the procedure?
After receiving sedation, an endoscopist, usually a
gastroenterologist (doctor who specializes in 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 endoscopist 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 into the
bile system and sometimes the pancreas while X-rays are taken. The contrast
agent allows the doctors to see the ducts of the bile system, gallbladder, and
pancreas 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 in the opening of
the bile duct, which can help small gallstones and bile to drain appropriately.
- Stent placement. A stent is an internal plastic drainage tube that is
placed in the bile duct and allows it to drain.
- Gallstone removal
Is the procedure safe?
ERCP carries with it a small risk of complications.
Complications requiring hospitalization may occur; however, they are uncommon.
These can include an inflammation of the pancreas known as pancreatitis,
infections, bowel perforation, and bleeding. Patients may experience tenderness
or a lump where the sedative was injected, but that should go away in a few
days. Your doctor will discuss your risk of possible complications before the
How should I prepare for the procedure?
- Be sure to tell your doctor if you are pregnant, have a lung or heart
condition, or if you are allergic to any medications. Also, tell the doctor
if you have an artificial heart valve or if you have ever been told you need
to take antibiotics before a dental or surgical procedure. You may need to
take antibiotics before the ERCP.
- If you have diabetes and use insulin, you may need to adjust the dosage
of insulin on 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.
- Tell your provider if you have kidney disease or require dialysis.
- Tell your provider if you are taking blood-thinning medications such as
Coumadin®, aspirin, Persantine®, or Plavix®.
Your primary care doctor may prescribe an alternate method for thinning your
blood before the procedure.
- Do not discontinue any medication without first consulting with your
primary care or referring doctor.
- Do not eat or drink anything for eight hours before the procedure.
You will need to bring a responsible adult to accompany you 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 during the procedure?
- Before the procedure, you will be given a hospital gown to wear and you
will be asked to remove your eyeglasses and dentures. The doctor performing
the procedure will discuss what will happen during the procedure and will
explain any risks. If you have any questions, now is the time to discuss
them with the doctor.
- An endoscopist experienced in ERCP performs the procedure, which lasts
from one to two hours. A local anesthetic (pain-relieving medication) may be
applied to the back of your throat. You are given a pain reliever and a
sedative intravenously (in your vein). You will feel relaxed and drowsy.
- A mouthpiece is placed in your mouth. It does not interfere with your breathing.
- Initially, you will lie on your left side during the procedure.
- The endoscopist inserts an endoscope through your mouth, down past your
stomach and into the first part of the small intestine (called the
duodenum). The endoscope does not interfere with your breathing.
- Contrast material is injected slowly into the pancreatic or biliary
ducts while X-rays are taken. The contrast agent enables the ducts to appear
on the X-rays.
What happens after the procedure?
- You will stay in a recovery room for about 1 to 2 hours for observation.
You may feel a temporary soreness in your throat. Lozenges may help.
- A responsible adult must accompany you after the procedure. It is also
recommended that a responsible adult 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 that you can
get to the emergency room quickly to be evaluated, if necessary.
The results will be sent to your primary care 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.
If you have severe abdominal pain, a continuous cough,
fever, chills, chest pain, nausea, or vomiting within 72 hours after the
procedure, call your doctor or go to the nearest emergency room.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/23/2009...#4951