Endoscopic Retrograde Cholangiopancreatography (ERCP)
What is the purpose of the test?
ERCP is useful to examine the bile ducts and pancreatic ducts for stones, tumors, narrowing and other abnormalities. White dye is injected into the ducts and taking x-ray films. If such problems are found, other procedures can be done through the ERCP scope to help correct them as described below.
How is the test done?
After you arrive and change into a gown, a nurse will ask you questions about your medical history and medicines you take. The nurse will put an IV into your arm and take you to the Fluoroscopy Room. You will be given oxygen to breathe. You will be hooked up to monitors that measure your blood pressure, heart rate and oxygen level during the test. Your doctor will explain the procedure and risks, and have you sign a consent form. The nurse will spray medication into your throat to make it numb, so that the endoscope will be easier to insert. The doctor will then give you a special medicine through the veins to sedate you. Most people will gradually lose awareness of their surroundings before the procedure begins.
When you are sedated, the doctor will place a long scope inside you through a plastic mouthpiece, and pass it into your esophagus. This has a video camera on it and will help the doctor to see your upper GI tract - esophagus, stomach, and upper duodenum - and locate the opening of the bile duct and pancreatic duct. If tissue is found that does not look normal, the doctor may take biopsies or remove tissues to do more studies. He will then pass a plastic catheter through the endoscope and inject a liquid dye into the bile ducts and pancreatic ducts. A radiologist will then take x-ray film of the dye. If stones are found, your doctor can extract the stones. If narrowing or blockage is found, your doctor can take samples then place a stent to hold the duct open and restore proper drainage. Most of these procedures take about 30 minutes to 2 hours after sedation to complete.
After the procedure, a nurse will monitor you and check your vital signs until you wake. Most patients find the procedure to be quite comfortable and are surprised when they wake and learn that it is over.
What are the risks of the test?
These procedures and tests are important to help the doctor examine you. Sometimes there are conditions which may prevent the doctor from completing the test such as location of opening, swelling or large stones. Many exams and tests have risks. At times, though unusual, a serious medical condition that is present may not be found in these exams. Other risks of ERCP include:
- Perforation of tissues
- Internal bleeding
- Aspiration pneumonia
- Heart attack
- Adverse reaction to medications
- Damage to teeth or dental work and
- Clotting or infection in the veins where medicine is given
Such complications can sometimes lead to surgery, or very rarely, death.
Are there other options to the test?
Several alternatives to ERCP are available, but may be less desirable. A CAT scan can investigate the bile ducts and pancreas, but cannot remove stones or blockages. CAT scans also miss at least 60% of bile duct stones. Percutaneous transhepatic cholangiography (PTC) inserts a needle through the liver to fill the bile ducts from above. PTC, however, is far less successful when the bile duct is not dilated, and only occasionally can be used to remove stones. PTC also cannot examine the pancreatic duct. MRI of the bile ducts and pancreas can be almost as sensitive as ERCP in detecting major pathology, but cannot be used to remove stones or relieve blockages. Of course, surgery can be used to explore these areas, but obviously is a much more invasive procedure.
Preparation for the test
You may have a regular diet up until the day of the procedure. On the day of your procedure, you may have only clear liquids and take your usual medicines (except for antacids and Carafate) up until 4 hours prior to your procedure. For the 4 hours prior to your procedure take nothing by mouth. This includes gum, lozenges, candy, and chewing tobacco.
Patients on aspirin or Plavix
If you take aspirin and/or Plavix due to a prior heart attack, stroke, heart rhythm problems, blood clots or have a heart stent in place, you should continue these medications. If you take aspirin daily but have no history of any of the above conditions, you should stop the aspirin five days prior to your exam.
Patients on Coumadin
If you take Coumadin or any other blood thinner such as Lovenox and have not been seen in our office, you will need to make an appointment with one of our physician assistants prior to scheduling your endoscopy.
Patients on iron, vitamins, herbal supplements
Stop any iron supplement or herbal remedies five days before your endoscopy. This includes multivitamins containing iron.
You must arrange for someone to drive you home, because you may be drowsy after the procedure and driving will be unsafe. Ask your driver come with you when you arrive to confirm your pick-up time. The procedure will not be done unless proper transportation arrangements have been made.
Feel free to call our office about the procedure or the preparation process with any questions.