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What is a ERCP?

Your doctor has recommended that you have a medical procedure called an ERCP

This brochure will help you understand why ERCP is performed and what you can expect from the procedure.

Endoscopic refers to the use of an instrument called an endoscope – a thin, flexible tube with a tiny video camera and light on the end. The endoscope is used by highly trained sub specialist, the gastroenterologist to diagnose and treat various problems of the GI tract.

The GI tract includes the stomach, intestine and other parts of the body that are connected to the intestine, such as the liver, pancreas and gallbladder.

Retrograde refers to the direction in which the endoscope is used to inject a liquid enabling X-rays to be taken of the parts of the GI tract called the bile duct system and pancreas.

The process of taking these X-rays is known as cholangipancreatography. Cholangio refers to the bile duct system, pancreatic duct to the pancreas.

ERCP may be useful in diagnosing and treating problems causing jaundice (a yellowing of the whites of the eyes) or pain in the abdomen. To understand how ERCP can help, its important to know more about the pancreases and the bile duct system

Bile is a substance made by the liver that is important in the digestion and absorption of fats. Bile is carried from the liver by a system of tubes known as bile ducts. One of these , the cystic duct connects the gallbladder to the main bile duct. The gall bladder stores the bile between meals and empties back in to the bile duct when food is consumed.

The common bile duct the empties in to a part of the small intestine called duodenum. The common bile duct enters the duodenum through a nipple like structure called the papilla.

Joining the common bile duct to pass through the papilla is the main duct from the pancreas. This pathway allows digestive juices from the pancreas to mix with the food in the intestine.

Problems that affect the pancreas and bile duct system can in many cases be diagnosed and corrected with ERCP.

Prior to having ERCP , there are a number of things you will need to remember:

First don’t eat or drink anything for atleast 6 hours beforehand or after midnight if your ERCP is scheduled first thing in the morning

Be sure to tell your doctor all the medications you are taking including aspirin, aspirin containing drugs, blood thinners etc.

Identify any allergies or reactions you have had to drugs, particularly antibiotics or pain medications.

Follow all of your doctor’s instructions regarding preparation for the procedures. ERCP can be done either as an out patient procedure or may require hospitalization.

Everything will be done to ensure your comfort. A sedative will be given through a vein in your arm. An endoscope is passes down your throat in to your esophagus and through the stomach in to your duodenum.

The doctor will use it to inspect the lining of your stomach and duodenum. You should not feel any pain but you may have a sense of fullness since air may be introduced to help advance the scope.

In the duodenum the instrument is positioned near the papilla the point at which the main ducts empty in tot the intestine. A small tube known as a cannula is threaded down through the endoscope and can be directed in to either the pancreatic or commoin bile duct. The cannula allows a special liquid contrast material a dye to be injected backwards – that is retrograde through the ducts.

X ray equipment is then used to examine and take pictures of the dye outlining the ducts. In this way widening, narrowing or blockage of the ducts can be pinpointed

Some of the problems that may be identified during ERCP can also be treated through the endoscope. For example if a stone is blocking the pancreatic or common bile duct it is usually possible to remove it.

First the opening in the papilla is cut open and enlarged. Then a special device can be inserted to retrieve the stone. Narrowing or obstruction can also have other causes such as scarring tumors. In some cases a plastic or metal tube (called stent) can be inserted to provide an opening. If necessary a tissue sample or biopsy can be obtained or a narrow area dilated.

When your ERCP is completed on an out patient basis you will need to remain under observation until your doctor or health care team has decided you can return home. Sometimes admission to the hospital is necessary.

When you do go home be sure you have arranged for someone to drive you since you are likely to be sleepy or drowsy due to the sedative.

Because of the air used during ERCP, you may continue to feel full and pass gas for a while and it is not usual to have soft stool etc. however if you notice bleeding from your rectum or black tarry stools, call your doctor

You should report vomiting, severe abdominal pain weakness or dizziness and fever over 100 degrees.