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December 7, 2016

Guide to ERCP Testing

Are you due for an ERCP (Endoscopic Retrograde Cholangiopancreatography) test? The highly trained physicians at InSite Digestive Health Care have put together ERCP guidebook that walks you through each step of the test and the procedure:

What is an ERCP?

An ERCP is a procedure used to diagnose and treat diseases of the gallbladder, bile ducts, pancreas, and liver. ERCP combines endoscopy and x-ray in order to gain access to bile ducts and pancreas to create detailed “road maps” and then use tiny instruments to fix problems found those areas.

How do I prepare for an ERCP?

Your health care professional usually provides written instructions about how to prepare for ERCP. To begin, the upper GI tract must be empty. Generally, food is stopped 8 hours ahead and all liquids held for at least 2 hours. Patients should tell their clinician about all health conditions they have, especially heart and lung problems, diabetes, and allergies. A complete list of medications and supplements is reviewed. You may be asked to temporarily stop taking medications that affect blood clotting or adjust other medications.

How is the ERCP performed?

To begin, patients usually arrive at the outpatient endoscopy unit of a hospital, where a nurse will have you change into a hospital gown and start an IV. Sometimes limited blood tests are checked. Typically an anesthesia professional sees you and discusses the deep sedation medication (usually propofol) that will be given to keep you comfortable and unaware of the procedure. Sometimes an antibiotic is given. Doctors and other medical staff monitor vital signs while patients are asleep. Radiology equipment is prepared. During ERCP, patients lie on their back or side on an x-ray table. The doctor guides an endoscope down the esophagus, through the stomach, and into the duodenum. Video is transmitted to a monitor within the doctor’s view. When the doctor locates the small bile duct opening, a catheter is slid through the endoscope and guided into the ducts, contrast dye injected and this allows the duct systems to be seen. Based on what is then diagnosed, different procedures may be performed. Gallstones might be removed after cutting open the tiny ductal opening to make it wide enough (this is called sphincterotomy). Tumors or narrowing might be biopsied or cell samples taken (cytology). Strictures (blockages) might be dilated with ballon catheters. Plastic or metal stent tubes might be placed and left in place after the ERCP, to allow bile or pancreas juice to drain where a blockage has stopped their flow. Occasionally, ERCP is done after gallbladder surgery, if a surgical bile leak is suspected, to find and stop the leak with a temporary stent.

These delicate “surgical” procedures all performed through an endoscope require our “therapeutic endoscopists” can maintain advanced endoscopic training and ongoing training in the newest techniques to a very high level of skill.

How long is the ERCP procedure?

The ERCP takes from 30 minutes to 2 hours. After the procedure, you may need to stay at the hospital for 1 to 2 hours until the sedative wears off.

What can I expect after my procedure?

After the ERCP, patients are moved to a recovery room. Sedation gradually wears off. Sometimes patients may not remember initial conversations with health care staff, as the sedatives reduce memory of events during and right after the procedure. During recovery, patients may feel bloated or sometimes have nausea, which can be treated. Patients may also have a sore throat, which can last a day or two. Outpatients usually go home after the procedure, though after complex procedures may need to stay overnight for observation. Patients will likely feel tired and should plan to rest for the remainder of the day. Diet and medication instructions will be given.

When will I know the outcome of my procedure?

Some ERCP results are available immediately after the procedure. Biopsy results are usually ready in a few days. Your doctor ordinarily will try to talk to you when you’re awake enough to recall the conversation, otherwise reaches you by phone for further discussion. If office follow-up is needed, you would be told when to seek an appointment.

For more information regarding an ERCP procedure, contact your gastroenterologist. Please be advised that information is general and may be different depending on your physician and his practice.

REFERENCES The National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/ercp/Pages/diagnostic-test.aspx http://www.gastro.net.au/tests-procedures/endoscopic-retrograde-cholangio-pancreatography.html