My Doctor Ordered an ERCP. What Should I Expect?
by: Gastro MD
If you’re being scheduled for an ERCP, you may have questions. That’s okay! We have answers. Let’s dig into the what and why of this procedure so that you’ll know what to expect and feel calm.
Endoscopic retrograde cholangiopancreatography (ERCP) is a medical procedure that combines upper gastrointestinal endoscopy and x-rays. It’s most often used to correct bile and pancreatic duct problems but can also help diagnose and treat issues in the liver and gallbladder.
Why Your Doctor Might Order an ERCP
For most diagnostic testing purposes, your doctor will likely use a noninvasive test first, such as magnetic resonance cholangiopancreatography (MRCP). However, an ERCP may be necessary if your bile or pancreatic ducts have become blocked. Blockage and narrowing of the ducts can be caused by:
● Acute pancreatitis
● Chronic pancreatitis
● Infection
● Inflamed gallbladder (possibly due to gallstones or cholecystitis)
● Pancreatic cysts and pseudocysts
● Trauma in the bile or pancreatic ducts (possibly due to surgical complications)
● Tumors
Beyond using an ERCP to open narrowed or blocked ducts, your doctor can also pass tiny tools through the endoscope to perform a biopsy or even remove tumors or gallstones. If your ducts have narrowed, your doctor may also insert temporary stents to help prevent bile leaks.
What Actually Happens During ERCP
ERCPs are generally performed by a gastroenterologist, although a surgeon with advanced training in gastrointestinal endoscopy may also complete the procedure.
Your doctor will guide a long, flexible, lighted tube (endoscope) through your mouth and throat. The endoscope will travel down your esophagus and into your stomach to reach the duodenum (the small intestine). Your doctor will then pass a flexible tube (catheter) through the scope to inject a special contrast dye into the organ. The dye makes the ducts visible through x-ray imaging called fluoroscopy.
What to Expect Before and During an ERCP
Your doctor will have specific instructions before your ERCP and will ask you about any prescription medicines, vitamins or supplements you’re currently taking. You may be directed to stop any medication that could conflict with the sedatives you’ll receive during the procedure. You’ll also need to stop taking medicine that affects blood clotting.
Because your doctor will need the most transparent view of your gastrointestinal tract, you will not be allowed to eat or drink liquids for eight hours before the procedure. This includes not smoking and not chewing gum. In some cases, you may also receive special instructions for eating a specific diet one to two days before the ERCP.
You’ll be sedated but awake (conscious sedation) during the procedure. Typically, the sedative will be delivered intravenously through a needle placed in your arm. You’ll also gargle a liquid anesthetic to numb your throat; a spray anesthetic is an alternative. A mouth guard will keep you from biting down on the endoscope.
The whole procedure typically takes between one and two hours, so you’ll be in and out before you know it!
