Patient education: Endoscopic retrograde cholangiopancreatography (ERCP) (The Basics)

What is endoscopic retrograde cholangiopancreatography? — Endoscopic retrograde cholangiopancreatography ("ERCP") is a procedure doctors use to look at the liver, pancreas, and bile ducts.

During ERCP, the doctor uses a thin tube with a light and a tiny camera on the end. This is called an "endoscope." It goes into the mouth and is passed down the throat and through the stomach into the intestines. The endoscope lets the doctor check the liver, pancreas, and bile ducts (figure 1). ERCP can be used to check for problems in these organs. It can also be used to treat certain conditions.

Why might I need ERCP? — ERCP might be done to:

●Get small pieces of tissue for a biopsy

●Check for a blockage in the bile ducts

●Treat blocked bile ducts

How do I prepare for ERCP? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get other tests, such as:

●Ultrasound

●CT scan

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or over-the-counter medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take or bring a bag with all of your medicines with you.

●Any allergies you have. You might be given a dye called "contrast" for this procedure. Tell your doctor if you are allergic to dye.

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●If you are pregnant or nursing

You will also get information about:

●Fasting – This means not eating or drinking anything for a period of time. The doctor will tell you how long you need to fast before ERCP. Your stomach needs to be empty to let the doctor see the area. Fasting also lowers the chance of vomiting during the procedure.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during ERCP? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. You might get medicines to help you relax. Or you might get general anesthesia to make you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●You will lie on a special table on your left side, stomach, or back. You might have your head turned to 1 side.

●They will use a special plastic mouthguard between your teeth. This will help keep your mouth open during the procedure and protect your teeth.

●The doctor will put the endoscope in your mouth. This will help the tube go down into your stomach and intestines. The scope has a camera and light that lets the doctor see inside your body. The pictures from the scope will display on a monitor in the room.

●The doctor might fill your small intestine with air to help see the area more clearly. The doctor will pass a tiny tube from the scope into the opening of the bile and pancreatic ducts. A dye is injected into the ducts. This helps them show up more clearly on X-rays.

●During ERCP, the doctor can:

•Look directly at the bile and pancreatic ducts

•Take out any stones that are seen in the ducts

•Make any narrow areas wider

•Take biopsies to send to the lab

●The scope will be removed from your mouth and throat when the procedure is finished.

●Most of the time, an ERCP takes about 2 hours.

What happens after ERCP? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off.

●As you recover, you might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●When you are ready to eat, you will start with clear liquids.

What are the risks of ERCP? — Your doctor will talk to you about all of the possible risks and answer your questions. Possible risks include:

●Infection of the bile ducts

●Pancreatitis (swelling or inflammation of the pancreas)

●Bleeding

●Damage to the esophagus, stomach, or small intestine

●Inhaling food or fluids into your lungs (aspiration)

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