Endoscopic Retrograde Cholangio-Pancreatography Procedure

ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts. It is used to treat conditions which arise from the biliary tract. The most common reasons to do ERCP include abdominal pain, weight loss, jaundice (yellowing of the skin), or an ultrasound or CT scan that shows gallstones or a tumour (mass) within these ducts – resulting in obstruction of the biliary and/or pancreatic ducts.

ERCP may be used before or after gallbladder surgery to assist in the performance of that operation. Bile duct stones can be diagnosed and removed with an ERCP. Tumours, both cancerous and noncancerous, can be diagnosed and then treated with by inserting stents (indwelling plastic or metallic tubes) that are used to bypass a blockage of the bile duct. Complications from gallbladder surgery can also sometimes be diagnosed and treated with ERCP.

In patients with suspected or known pancreatic disease, ERCP will help determine the need for surgery or the best type of surgical procedure to be performed. Occasionally, pancreatic stones can be removed by ERCP.

Prior to undergoing an ERCP, you will be required to be nil-by-mouth for 6-8 hours prior to the ERCP. This will allow for sufficient time for your stomach to be empty, and to allow for a safe procedure. Dr. Coovadia will be more specific about the time to begin fasting depending on the time of day that your test is scheduled.

Your current medications may need to be adjusted or avoided. Most medications can be continued as usual. Medication use such as aspirin, Vitamin E, non-steroidal anti-inflammatories, blood thinners and insulin should be discussed with your physician prior to the examination as well as any other medication you might be taking. It is therefore best to inform your medical team of any allergies to medications, iodine, or shellfish. It is essential that you alert Dr. Coovadia if you require antibiotics prior to undergoing dental procedures, since you may also require antibiotics prior to ERCP.

Also, if you have any major diseases, such as heart or lung disease that may require special attention during the procedure, discuss this with Dr. Coovadia prior to the ERCP.

To make the examination comfortable, you will be sedated during the procedure. Sedatives will affect your judgment and reflexes for the rest of the day, so you should not drive or operate heavy machinery until the next day.

Your anaesthetist will spray your throat with a local anaesthetic before the test begins to numb your throat and prevent gagging. You will be given medication intravenously to help you relax during the examination. While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your oesophagus, and into your stomach and duodenum. The procedure usually lasts about an hour, but this may vary depending on the planned intervention. The endoscope does not interfere with your breathing. Most patients fall asleep during the procedure. You may feel temporarily bloated during and after the procedure due to the air used to inflate the duodenum.

You will be monitored in the endoscopy area for 1-2 hours until the effects of the sedatives have worn off. Your throat may be sore for a day or two. You will be able to resume your diet and take your routine medication after you leave the endoscopy area, unless otherwise instructed. Following your ERCP, you will spend the next 12-24 hours in hospital for observation.

Dr. Coovadia will usually inform you of your test results on the day of the procedure. Biopsy results take several days to return, and you should plan with your physician to get these results. The effects of sedation may make you forget what you were instructed to do after the procedure.

ERCP is safe when performed by gastroenterologists who have had specific training and are experienced in this specialized endoscopic procedure. Complications are rare; however, they can occur. Pancreatitis due to irritation of the pancreatic duct by the X-ray contrast material or cannula is the most common complication. A reaction to the sedatives can occur. Irritation to the vein in which medications were given is uncommon but may cause a tender lump lasting a few days. Warm moist towels will help relieve this discomfort.

If your ERCP included a therapeutic procedure such as removal of stones or placement of a stent (drain), there are additional small risks of bleeding or perforation (making a hole in the intestine or bile duct). Blood transfusions are rarely required. It is important for you to recognize the early signs of complications such severe abdominal pain, fever, chills, vomiting, or rectal bleeding and to contact Dr. Coovadia or the Mediclinic Panorama Emergency Centre if you notice any of these symptoms.