Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP is a procedure that enables your physician to examine the pancreatic and bile ducts looking for abnormalities such as stones, tumors, blockages, irregularity in the tissue, and problems with the flow of bile or pancreatic fluid. If a problem is found, the endoscopist can often perform a procedure to repair or improve the condition. As a result of its therapeutic option, ERCP has replaced surgery in most patients with common bile duct and pancreatic disease.
The functions of the common bile duct and the pancreatic duct are to drain the gallbladder, liver, and pancreas. The two main ducts convey the bile and the pancreatic juice through the papilla into the duodenum (the first part of the small intestine). The most common reason why someone would need an ERCP is because of a blockage of one of these ducts (often due to gallstones). During ERCP, a bendable special endoscope (tube with a camera at the tip) is placed through your mouth and into your stomach and first part of the small intestine (duodenum). In the duodenum a small opening is identified (ampulla) and a small plastic tube is passed through the endoscope and into this opening. Dye (contrast material) is injected and X-rays are taken to study the ducts of the pancreas and liver. ERCP combines X-ray and endoscopy, allowing your physician to obtain high-quality images of the anatomy.
Depending of your problem, your physician can widen the opening (ampulla) by cutting, and remove stones from the bile/pancreatic ducts by special balloons or baskets. In some cases with obstructing lesions of the ducts, your physician can put small plastic or metallic stents (through which bile or pancreatic juice can flow) across the obstructed area to enable drainage.
How should I prepare for my ERCP?
You should not have anything to eat or drink for approximately 8 hours before your ERCP. Typically, patients are asked to refrain from eating or drinking after midnight the night before their test.
Your physician may ask you to hold any anti-agregant or anti-coagulant (blood thinning) medications for 5-7 days before your test depending of your situation or if sampling is needed. You may be allowed to take your other medications on the morning of your test. It is extremely important that you tell your physician what medications you are on (like aspirin, ecopirine, plavix (clopidogrel), eliquis, pradaxa, xarelto, lixiana, coumadine) and discuss if any need to be stopped before the test. If you have a heart disease or severe comorbidity, you may be required to get an opinion from your heart doctor or primary physician responsible for your care stating that it is safe for you to have an ERCP and receive sedation.
What are the reasons why I need an ERCP*?
- Bile duct stones
- Bile duct or pancreatic duct tumors
- Bile duct or pancreatic duct obstruction (because of tumors or noncancerous lesions)
- Pancreatic duct stones
- Chronic pancreatitis
- Also complications from gallbladder surgery can also sometimes be diagnosed and treated with ERCP.
*Shown are common indications. Rare reasons not listed.
