ESCPEndoscopic Retrograde Cholangiopancreatography (ERCP) is a test performed using an endoscope to diagnose and treat various problems of the gastrointestinal (GI) tract. The GI tract includes the stomach, intestines, and organs that connect to the intestines such as the liver, pancreas, and gallbladder. A special liquid dye is introduced through the endoscope to enable X-rays of organs such as the bile duct system and pancreas. The direction in which the dye is inserted is called “retrograde.” The process of taking these X-rays is known as cholangiopancreatography. “Cholangio” refers to the bile duct system, “pancrea” to the pancreas.

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  • Bile: Bile is a substance made by the liver that helps the body digest and absorb fat. 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 gallbladder stores the bile between meals and empties into the bile duct when food is consumed. The common bile duct then empties into a part of the small intestine called the “duodenum.” The common bile duct enters the duodenum through a nipple-like structure called the “papilla.”  ERCP can detect a blockage of the bile ducts by gallstones, tumors, scarring, or other conditions that cause obstruction or narrowing (stricture) of the ducts.
  • Pancreas: 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 food in the intestine. A blockage of the pancreatic ducts from stones, tumors, or stricture can cause pancreatitis (inflammation of the pancreas). Problems that affect the pancreas can be diagnosed and corrected using the ERCP procedure.

Preparation

Regardless of why an ERCP has been recommended for you, there are important steps you can take to prepare for and participate in the procedure.

  • Provide a complete list of all the medicines you are taking — including any over-the-counter medications and natural supplements — and any allergies to drugs or other substances.
  • Dr. Ranvir Singh, Dr. Stephen Rashbaum, and Dr. Nitin J. Parikh will also want to know if you have a heart, lung or other medical condition that may need special attention before, during or after an ERCP.
  • It is important they know if you are taking diabetic medications or anticoagulants (sometimes called blood thinners) or have bleeding or clotting problems.
  • Do not eat or drink anything for at least six hours beforehand or after midnight if your ERCP is scheduled for first thing in the morning.
  • You will be asked to sign a form, which verifies that you consent to having the procedure and that you understand what is involved. If there is anything you don’t understand, ask for more information.
  • Follow all of your doctor’s instructions regarding preparation for the procedure.

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About the Procedure

ERCP can be done either as an outpatient procedure or may require hospitalization depending on the individual case. Everything will be done to ensure the patient’s comfort. Blood pressure, pulse, and the oxygen level in the blood will be carefully monitored. A sedative will be given through a vein in the arm. The patient will feel drowsy, but will remain awake and able to cooperate during the procedure. Although general anesthesia is usually not required, the back of the throat may be sprayed with a local anesthetic to minimize discomfort as the endoscope is passed down the throat into the esophagus. Then through the stomach into the duodenum. Dr. Ranvir Singh, Dr. Stephen Rashbaum, and Dr. Nitin J. Parikh will inspect the lining of the stomach and duodenum. There should be no pain, but there may 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 into the intestine. A small tube known as a cannula is threaded down through the Endoscope and can be directed into either the pancreatic or common bile duct. The cannula allows a special liquid contrast material (dye), to be injected backwards, i.e., 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.

If there is a blockage of the bile duct(s) by gallstones or tumors, it can be removed. First, the opening in the papilla is cut open and enlarged. Then, a special device can be inserted to retrieve the stone. In some cases, a plastic or metal tube (called a stent), can be inserted to provide an opening. If necessary, a tissue sample or biopsy can be obtained, or a narrow area dilated.

Aftercare and Recovery

When the ERCP is completed on an outpatient basis, the patient will need to arrange for someone to drive him/her to and from the procedure, and the patient will need to remain under observation until Dr. Ranvir Singh, Dr. Stephen Rashbaum, or Dr. Nitin J. Parikh has decided the patient can return home. Sometimes, admission to the hospital is necessary. Once at home the patient will need to avoid operating machinery for a day, and not drink any alcohol. Because of the air used during ERCP, it is possible to feel full and pass gas for awhile. It is not unusual to have a soft stool or other brief changes in bowel habits; however, if there is bleeding from the rectum or black, tarry stools, vomiting, severe abdominal pain, weakness or dizziness, and a fever over 100 degrees, call Digestive Care Physicians immediately.


Board-Certified physicians Dr. Ranvir Singh, Dr. Stephen Rashbaum, and Dr. Nitin Parikh, Dr. Sumana Moole, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; Vanessa T. Dang, MSN, APRN; care for patients in the the North Atlanta, GA; area including Johns Creek GA; Cumming GA; and Lawrenceville, GA. The In-House Endoscopy Suite at Digestive Care Physicians is a certified facility which has achieved the highest level of accreditation by the Association for Ambulatory Health Care (AAAHC). If you suffer from gastrointestinal problems or need a colorectal cancer screening, contact us at (770) 227-2222 to schedule an appointment.