Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that allows the physician to diagnose and treat problems in the liver, gallbladder, bile ducts and pancreas. 

• The procedure combines X-ray and the use of a side-viewing endoscope – a long, flexible, lighted tube.  The scope is guided through the patient’s mouth and throat, then through the esophagus, stomach and duodenum (first part of the small intestine).   The physician can examine the inside of these organs and detect any abnormalities.  A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an X-ray.
• ERCP may be indicated for the removal of ductal gall stones.

Reasons for an ERCP
ERCP may be performed to assess the liver, gallbladder, biliary tree, and/or pancreas for the cause of unexplained abdominal pain or jaundice (yellowing of the skin and eyes due to bile pigments in the blood). ERCP may be used to obtain further diagnostic information in the presence of pancreatitis or cancer of the liver, pancreas, or bile ducts.

Blockages and/or stones in the bile ducts, fluid leakage from the bile or pancreatic ducts, obstructions or narrowing of the pancreatic ducts, or tumors may be found with ERCP.

There may be other reasons for your physician to recommend an ERCP.

The ERCP Procedure
An ERCP may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, an ERCP follows this process:

1. You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
2. You will be asked to remove clothes and put on a gown prior to the procedure.
3. An intravenous (IV) line will be inserted in your arm or hand.
4. You may receive oxygen through a nasal cannula (tube) during the procedure.
5. You will be positioned on your left side on the x-ray table.
6. Numbing medication will be sprayed into the back of your throat to prevent gagging as the endoscope is passed down your throat into your stomach. You will not be able to swallow the saliva that may collect your mouth during the procedure due to the endoscope in your throat. The saliva will be suctioned from your mouth from time to time.
7. A mouth guard will be placed in your mouth to keep you from biting down on the endoscope and to protect your teeth.
8. Once your throat is numbed and you are sufficiently relaxed from the sedative, the physician will ask you to swallow the endoscope. By using the endoscope’s camera system, the physician will guide the endoscope down the esophagus into the stomach and through the duodenum until it reaches the ducts of the biliary tree.
9. When the endoscope is in place, you will be asked to lie flat on your back.
10. A small tube will be passed through the endoscope to the biliary tree, and contrast dye will be injected into the ducts. Air may be injected prior to the injection of the contrast dye. Injection of air may cause you to have a sense of fullness in your abdomen.
11. Various x-ray views will be taken. You may be asked to change positions during this time.
12. After x-rays of the biliary tree are taken, the small tube for dye injection will be repositioned to the pancreatic duct. Contrast dye will be injected into the pancreatic duct, and x-rays will be taken. Again, you may be asked to change positions while the x-rays are taken.
13. If needed for your specific situation, samples of fluid and/or tissue may be taken at any time during the procedure. Other procedures, such as the removal of gallstones or other obstructions, may be performed while the endoscope is in place.
14. After the x-rays and any other procedures have been completed, the endoscope will be withdrawn.

After the Procedure
After the procedure, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If this procedure was performed as an outpatient, you should plan to have another person drive you home.

You will not be allowed to eat or drink anything until your gag reflex has returned. You may notice some soreness of your throat and pain with swallowing for a few days. This soreness is normal.

You may resume your usual diet and activities after the procedure, unless your physician advises you differently.

Notify your physician to report any of the following:

• Fever and/or chills
• Redness, swelling, or bleeding or other drainage from the IV site
• Abdominal pain, nausea, and/or vomiting
• Black, tarry, or bloody stools
• Swallowing difficulties
• Throat or chest pain that worsens

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

For more information, please call 1-87-PLH-GILAB (1-877-544-4522) today!