Endoscopic Retrograde Cholangiopancreatography (ERCP)

A Combination X-Ray and Endoscope Procedures

An ERCP is a test performed at Forsyth Medical Center by our physicians using an x-ray to look into the bile and pancreatic ducts. The doctor inserts an endoscope through the mouth into the duodenum and bile ducts. Dye is sent through the tube into the ducts. This allows the ducts to show up on an x-ray. An ERCP is used to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery) and cancer. You will be sedated, so you will need someone to drive you home from the hospital.

What is an ERCP?

During an ERCP, your doctor will pass an endoscope through your mouth, esophagus and stomach into the duodenum (first part of the small intestine). An endoscope is a thin, flexible tube that lets your doctor see inside your bowels. After your doctor sees the common opening to ducts from the liver and pancreas, your doctor will pass a narrow plastic tube called a catheter through the endoscope and into the ducts. Your doctor will inject a contrast material (dye) into the pancreatic or biliary ducts and will take X-rays.

How should I prepare for the procedure?

You should fast for at least 6 hours (preferably overnight) before the procedure to make sure you have an empty stomach. This is necessary for the best examination. Your doctor will give you precise instructions about how to prepare.

You should talk to your doctor about any heart or lung conditions or any major diseases you have, medications you take regularly and any allergies you have to medications, or intravenous contrast material. Although these factors don’t necessarily prevent you from having an ERCP, it’s important to discuss it with your doctor prior to the procedure.

What can I expect during an ERCP?

Your doctor might apply a local anesthetic to your throat or give you a sedative to make you more comfortable. Some patients also receive antibiotics before the procedure. You will lie on your left side on an X-ray table. Your doctor will pass the endoscope through your mouth, esophagus, stomach and into the duodenum. The instrument does not interfere with breathing.

What can I expect after an ERCP?

If you have an ERCP as an outpatient, you will be observed for complications until most of the effects of the medications have worn off. You might experience bloating or pass gas because of air introduced during the examination. You can resume your usual diet unless you are instructed otherwise.

Someone must accompany you home from the procedure because of the sedatives used during the examination. Even if you feel alert after the procedure, the sedatives can affect your judgment and reflexes for the rest of the day.

 What are possible complications of an ERCP?

Complications are uncommon, but possible (as with any procedure). Risks vary depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems. Patients undergoing a therapeutic ERCP, such as for stone removal, face a higher risk of complications than patients undergoing a diagnostic ERCP. Complications can include pancreatitis (an inflammation or infection of the pancreas), infections, bowel perforation and bleeding. Some patients can have an adverse reaction to the sedative used. Sometimes the procedure cannot be completed for technical reasons. Your doctor will discuss your likelihood of complications before you undergo the test.