ERCP

What is endoscopic retrograde cholangiopancreatography (ERCP)?
ERCP is a way to evaluate the bile ducts that drain your liver and to examine your pancreas. After making the patient comfortable and sleepy with medications, a flexible camera instrument (endoscope) is passed through the mouth into the first part of the small intestine (duodenum) where the openings to the bile and pancreas ducts are located. With delicate instruments, x-rays and contrast, your doctor is able to carefully evaluate your bile ducts and pancreas. ERCP allows your gastroenterologist to remove bile duct or pancreatic duct stones by widening the opening (sphincterotomy) or by fragmenting the stones (lithotripsy). Plastic or metal tubes can be used to treat strictures (narrowed area causing blockage). If needed, tissue samples can be taken painlessly from the bile duct and pancreas opening (papilla) or from within the bile ducts by ERCP.

When may ERCP be necessary?

  • To evaluate and treat jaundice (yellowing of the skin and eyes)
  • To evaluate and treat suspected stones in the bile duct or pancreatic duct
  • To evaluate and treat blockages of the bile duct and pancreatic duct
  • To evaluate and treat leaks of the bile duct, especially after gallbladder surgery
  • Suspected pancreas cancer

What are some alternatives to ERCP?
Surgery is more invasive and requires general anesthesia, but is sometimes required if ERCP cannot treat the medical condition. For some conditions, a different endoscopic test called EUS, or Endoscopic Ultrasound, is more appropriate. Patients are referred to one of the teaching hospitals in Philadelphia for this highly specialized test.

Percutaneous trans-hepatic cholangiogram (PTC) is a procedure where a needle is used to puncture the skin to gain access to the bile ducts. PTC is usually only used if ERCP cannot be performed because PTC has higher risks of bleeding, infection and damage to organs and blood vessels.

You should ask your doctor about these choices.

How do I prepare for an ERCP?
Follow your doctor’s instructions. Avoid any aspirin, ibuprofen, naprosyn or other non-steriodal anti-inflammatory drugs (NSAIDS) for 7 days prior to the procedure. Avoid any anti-platelet agents such as Plavix (clopidogrel), Ticlid (ticlopidine) and Aggrenox for 7 days prior to the procedure. Stop Coumadin (warfarin) for 4 days prior to the procedure. If you take any of these medications regularly, ask your primary care physician or cardiologist whether you need to instead take Lovenox or a different medication prior. Eat a light meal the evening before the procedure and do not eat or drink anything after midnight. Plan for care and recovery time after your ERCP is over. On rare occasions, patients may be required to stay overnight in the hospital for observation.

The ERCP procedure is performed in the Radiology department of Chester County Hospital, and you initially check in at the ACC – Ambulatory Care Center. This is on East Marshall Street, near the Emergency Room. For directions, see the Chester County Hospital website, www.cchosp.com. After you check into the ACC, a small sterile catheter will be placed in a vein of your arm. After you are brought to Radiology, medicine will be injected through this catheter just before the procedure to make you sleepy and relaxed. During the procedure, your blood pressure, heart rate, and blood oxygen level are monitored.

What happens after the procedure?
After the examination, you will be taken to a recovery area. Most people have no recollection of the procedure because of the amnesic effects of the medicine. After the procedure, you will feel drowsy and may sleep for a short time. The effects of the medicine will wear off quickly, but you will not be allowed to drive yourself home, as it is unsafe. Before you leave the hospital, your doctor will discuss the procedure findings and treatment plans with you. You should have a family member or trusted friend present during this discussion, as the medication you received may make you forgetful.

If a sphincterotomy (widening the bile duct or pancreatic duct opening with a small cut) is performed, you will need to avoid aspirin, ibuprofen, naprosyn or other non-steriodal anti-inflammatory drugs (NSAIDS) and any “blood-thinners” such as Plavix (clopidogrel), Coumadin (warfarin) or Ticlid (ticlopidine) for at least 7 days after the procedure. Take Tylenol (acetaminophen) instead if approved by your primary care physician.

Ask your doctor for specific instructions and when you should come back for a checkup.

What are the risks associated with this procedure?
Today, ERCP is a routine procedure but on occasion problems do occur. Some risks include but are not limited to: pancreas inflammation (pancreatitis; can be severe enough to necessitate a stay in the hospital), bleeding that may require blood transfusions, perforation or tear, infection that may require antibiotics and hospitalization, heart or lung problems. If problems occur you may require surgery or hospitalization that could rarely be prolonged.

When should I call the doctor?
Call the doctor immediately if you develop abdominal pain, nausea or vomiting that does not resolve; or if you develop a fever.

Call the doctor during regular office hours if you have questions about the procedure or its result; or if you wish to make another appointment.