What is ERCP?
Your doctor has recommended that you have a medical procedure called an ERCP. ERCP is short for… Endoscopic Retrograde Cholangio Pancreatography. Endoscopic refers to the use of an instrument called an endoscope - a thin, flexible tube with a tiny video camera and light on the end. The endoscope is used by a highly trained subspecialist, the gastroenterologist, to diagnose and treat various problems of the GI tract. The GI tract includes the stomach, intestine, and other parts of the body that are connected to the intestine, such as the liver, pancreas, and gallbladder.
What preparation is required?
Prior to having ERCP, there are a number of things you will need to remember:
First, don’t eat or drink anything for at least six hours beforehand or after midnight if your ERCP is scheduled for first thing in the morning.
Be sure to tell your doctor all the medication you are taking, including aspirin, aspirin-containing drugs, or blood thinners.
Identify any allergies or any reactions you have had to drugs, particularly antibiotics or pain medications.
Follow all of your doctor’s instructions regarding preparation for the procedure.
ERCP can be done either as an outpatient procedure or may require hospitalization, depending on the individual case. Your doctor will explain the procedure and its benefits and risks, and you will be asked to sign an informed consent form. This form verifies that you agree to have the procedure and understand what’s involved.
What can I expect during ERCP?
Everything will be done to ensure your comfort. Your blood pressure, pulse, and the oxygen level in your blood will be carefully monitored. A sedative will be given through a vein in your arm. You will feel drowsy, but will remain awake and able to cooperate during the procedure.
Although general anesthesia is usually not required, you may have the back of your throat sprayed with a local anesthetic to minimize discomfort as the endoscope is passed down your throat into your esophagus (the swallowing tube), and through the stomach into your duodenum.
The doctor will use it to inspect the lining of your stomach and duodenum. You should not feel any pain, but you may have a sense of fullness, since air may be introduced to help advance the scope.
What are the Possible Complications from an ERCP?
Thanks to ERCP, these kinds of procedures may help you avoid surgery. Depending on the individual and the types of procedures performed, ERCP does have a five to ten percent risk of complications. In rare cases, severe complications may require prolonged hospitalization.
Mild to severe inflammation of the pancreas is the most common complication and may require hospital care, even surgery. Bleeding can occur when the papilla has to be opened to remove stones or put in stents. This bleeding usually stops on its own, but occasionally, transfusion may be required or the bleeding may be directly controlled with endoscopic therapy.
A puncture or perforation of the bowel wall or bile duct is a rare problem that can occur with therapeutic ERCP. Infection can also result, especially if the bile duct is blocked and bile cannot drain. Treatment for infection requires antibiotics and restoring drainage. Finally, reactions may occur to any of the medications used during ERCP, but fortunately these are usually minor.
Be sure to discuss any specific concerns you may have about the procedure with your doctor.
What can i expect after ERCP?
When your ERCP is completed, you will need to remain under observation until your doctor has decided you can return home. Sometimes, admission to the hospital is necessary.
When you do go home, be sure you have arranged for someone to drive you, since you’re likely to be sleepy from the sedative you received. This means, too, that you should avoid operating machinery for a day, and not drink any alcohol.
Your doctor will tell you when you can take fluids and meals. Usually, it is within a few hours after the procedure.
Because of the air used during ERCP, you may continue to feel full and pass gas for a while, and it is not unusual to have soft stool or other brief changes in bowel habits. However, if you notice bleeding from your rectum or black, tarry stools, call your doctor.
You should also report vomiting, severe abdominal pain, weakness or dizziness, and fever over 100 degrees. Fortunately, these problems are not common.
ERCP is an effective and useful procedure for evaluating or treating a number of different problems of the GI tract.
You should also make sure you follow your doctor's preparation instructions carefully.
DR. RAVINDRAN KUMERAN
MBBS, MSC (LON), DNB, FRCS (Ed (G.I.SURG), FRCS (GLASG)
Sr. Consultant Surgical Gastroenterologist, Laproscopy
& Obesity Specialist
MBBS, MD (Internal Medicine), DM (Medical Gastroenterology),
Consultant Medical Gastroentrologist