ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

Endoscopic retrograde cholangiopancreatography, or ERCP, is an x-ray test that is used to diagnose diseases of the liver, gall bladder, pancreas and bile ducts. It is done by passing a small, thin, flexible, lighted tube through your throat, into your stomach, and to the beginning of the gastrointestinal, or GI, tract. This tube is called an endoscope. The examiner will be able to see the stomach and intestines through this scope. A narrow plastic tube, called a catheter, is then passed through the scope and into the ducts leading from the liver and pancreas. A special dye is injected into the ducts to make them easier to see on x-rays.

There are several organs that play a role in digestion. The liver is a large organ that makes a liquid, called bile, that helps with digestion. The gallbladder stores the bile until it is needed for digestion. The pancreas is a large gland that produces hormones, such as insulin, and enzymes that help with digestion. Ducts are drainage tubes that carry bile from the liver to the small intestines.

Sometimes the drainage in a duct can form stones that cause a blockage. If the bile duct from the gallbladder is blocked, it will cause bile to be backed up. This results in jaundice, a yellow coloring of the skin. If the pancreatic duct is blocked, digestion shuts down and the pancreas becomes inflamed. An ERCP allows these organs to be seen so a diagnosis can be made.

To prepare for the test, you should not eat or drink after midnight, or for at least 6 hours before the test. The stomach must be empty to get the best x-rays. Be sure to tell your healthcare provider if you have any heart, lung, or other major diseases; if you are allergic to medications or iodine dyes; or if you had a barium enema within a week of this test. Barium will interfere with the results of this test.

ERCP is an outpatient procedure. It usually lasts about 30 minutes to 2 hours. You may be given a mild sedative to relax, but you will be awake during the test. The back of your throat will be sprayed with a local anesthetic to prevent gagging on the scope. This may taste bitter and make your tongue and throat feel swollen. An IV will be started so medications can be given to relax the muscles of the stomach and small intestine. Occasionally, these drugs may cause nausea, vomiting, hives, dry mouth, thirst, blurred vision, or retention of urine.

You will lie on an x-ray table on your left side, with your left arm behind you. The scope will be passed through your mouth and into your stomach, until it reaches the opening to the small intestine. The scope will not interfere with your breathing. But you might feel a bloating sensation because of the air introduced through it. If so, take slow, deep breaths.

A thin tube will be passed through the endoscope. A contrast dye is injected through this tube into the ducts. This makes the ducts show up clearly on x-rays. You may feel some discomfort in your stomach when the dye is injected. X-rays are taken as soon as the dye is injected.

Examiners view the movement of the dye by fluoroscopy and still x-rays. Fluoroscopy is a continuous x-ray that creates a moving image, which can be seen on a monitor. The examiner may also remove a small piece of tissue that can be examined later in the laboratory. This procedure is called a biopsy. If the x-rays show gallstones or narrowing of the ducts, instruments can be passed through the scope to remove the stone or widen the obstruction.

If the test is done as an outpatient, you will be kept for a few hours, until most of the effects of the medications have worn off. Even if you think you are alert enough, the sedatives can affect your judgment and reflexes for the rest of the day. So, be sure to arrange to have someone there to drive you home after the test. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.

After the procedure:

do not eat or drink for at least 1 hour; your throat may still be numb, causing you to choke if you eat or drink too soon
after 1 hour, try taking small sips of water; then try other liquids; once you can swallow easily, you may have solid food
your throat may feel sore when the anesthetic wears off; this discomfort

may last for 3 to 4 days; throat lozenges and gargling with warm salt water will help

you may feel dizzy, nauseated or drowsy from the medications, so a nurse will help you to a recovery area
you may feel bloated and pass a soft bowel movement because of the air and dye used during the test
you may have a tenderness or lump where the sedative was injected, but that should go away in a few days
do not drive until the day after this procedure

There is a slight risk that the procedure itself may cause inflammation of the bile ducts or the pancreas.

Call your provider if you vomit, have severe abdominal pain, or have a fever.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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