Endoscopic Retrograde Cholangiopancreatography (ERCP), is a study of the ducts that drain the liver and pancreas. Ducts are drainage routes into the bowel. The ones that drain the liver and gallbladder are called bile or biliary ducts. The one that drains the pancreas is called the pancreatic duct. The bile and pancreatic ducts join together just before they drain into the upper bowel from the stomach. The drainage opening is called the papilla. There are two types of ERCP testing – Diagnostic ERCP and Therapeutic ERCP. Both tests are performed using an Endoscope to view the Gastrointestinal (GI) tract including the stomach, intestines, and organs that connect to the intestines, such as the liver, pancreas, and gallbladder.
Diagnostic: Diagnostic ERCP uses an X-ray contrast dye to take pictures of the GI tract or “diagnose” a problem. If a problem is found, it can be corrected during the diagnostic procedure. Learn more+
Therapeutic: Therapeutic ERCP also takes pictures but primarily allows for treatment of an identified problem. The most common procedures performed using ERCP include
- Stone Removal
- Stent Placement
- Balloon Dilation
- Tissue Sampling
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. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Sumana Moole, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; 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 have 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.
Learn more about ERCP preparation+
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 your comfort. Your blood pressure, pulse, and the oxygen level in your blood will be carefully monitored. A sedative will be given through a vein in your arm. You will feel drowsy but will remain awake and able to cooperate during the procedure. Although general anesthesia is usually not required, you may have the back of your throat sprayed with a local anesthetic to minimize discomfort as the endoscope is passed down your throat into your esophagus, and through the stomach into your duodenum. Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Sumana Moole, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; will 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 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. At this point, widening, narrowing, or blockage of the ducts can be pinpointed and corrected.
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, you will need to remain under observation until Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Sumana Moole, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; have 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’re likely to be sleepy from the sedative you received. This means, too, that you should avoid operating machinery for a day, and not drink any alcohol. Because of the air used during ERCP, you may continue to feel full and pass gas for a while. It is not unusual to have a soft stool or other brief changes in bowel habits; however, if you notice bleeding from your 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 north Atlanta, GA; area including Johns Creek, GA; Cumming, GA; Alpharetta, 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 liver testing, contact us at (770) 227-2222 to schedule an appointment.