Endoscopic retrograde cholangiopancreatography is a procedure that combines upper gastrointestinal (GI) endoscopy and x rays to treat problems of the bile and pancreatic ducts. ERCP is also used to diagnose problems, but the availability of non-invasive tests such as magnetic resonance cholangiography has allowed ERCP to be used primarily for cases in which it is expected that treatment will be delivered during the procedure.

Preparation

The health care provider usually provides written instructions about how to prepare for ERCP. The upper GI tract must be empty. Generally, no eating or drinking is allowed 8 hours before ERCP. Smoking and chewing gum are also prohibited during this time.

Patients should tell their health care provider about all health conditions they have, especially heart and lung problems, diabetes, and allergies. Patients should also tell their health care provider about all medications they take. Patients may be asked to temporarily stop taking medications that affect blood clotting or interact with sedatives, which are usually given during ERCP to help patients relax and stay comfortable.

Medications and vitamins that may be restricted before and after ERCP include:

• nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil), and naproxen (Aleve)
• blood thinners
• high blood pressure medication
• diabetes medications
• antidepressants
• dietary supplements

Driving is not permitted for 12 to 24 hours after ERCP to allow the sedatives time to completely wear off. Before the appointment, patients should make plans for a ride home.

During the Procedure

ERCP is conducted at a hospital or outpatient center by a doctor and assistants who have specialized training in this procedure. Patients receive a local anesthetic that is gargled or sprayed on the back of the throat. The anesthetic numbs the throat and calms the gag reflex. An intravenous needle is inserted into a vein in the arm if sedatives will be given. Doctors and other medical staff monitor vital signs while patients are sedated.

During ERCP, patients lie on their back or side on an x-ray table. The doctor inserts an endoscope down the esophagus, through the stomach, and into the duodenum. Video is transmitted from a small camera attached to the endoscope to a computer screen within the doctor’s view. Air is pumped through the endoscope to inflate the stomach and duodenum, making them easier for the doctor to examine.

After the Procedure

After ERCP, patients are moved to a recovery room where they wait for about an hour for the sedatives to wear off. Patients may not remember conversations with health care staff, as the sedatives reduce memory of events during and after the procedure. During this time, patients may feel bloated or nauseous. Patients may also have a sore throat, which can last a day or two. Patients can go home after the sedatives wear off. Patients will likely feel tired and should plan to rest for the remainder of the day. Some ERCP results are available immediately after the procedure. Biopsy results are usually ready in a few days.

Source

ERCP (Endoscopic Retrograde Cholangiopancreatography), National Digestive Diseases Information Clearinghouse (NDDIC), June 29, 2012.

For more information:

Go to the Digestive Disorders health topic.