What is an ERCP?
An ERCP is a medical procedure that allows your doctor to examine the ducts or ‘drain tubes’ of the liver, pancreas and gallbladder. It involves passing an endoscope (a long, thin flexible tube with a video camera at the end) through the mouth and stomach to where the ducts join the small intestine. A small plastic instrument is then inserted through the endoscope and into the bile and/or pancreatic duct. Often a small cut is made in the opening of the ducts (a sphincterotomy) to allow better drainage. Xrays are then taken and other procedures such as removing stones, stretching a narrowing or placing a stent can be performed. An ERCP is performed in a hospital and usually requires an overnight stay.
Why is an ERCP done?
An ERCP is done to treat specific conditions related to the ‘drain tubes’ of the liver, gallbladder and pancreas. These include removing stones that might be causing an infection or blocking the duct, taking biopsy samples, and stretching or placing a stent across a narrowing within the duct.
How do I prepare for an ERCP?
It is important for the safety and accuracy of your procedure that your stomach is completely empty. You should therefore have nothing to eat or drink for 6 hours prior to your ERCP.
Whilst most medications can be taken as usual with a sip of water on the day of your procedure, some medications need to be stopped, or have their dose altered.
You should notify your specialist at least 7 days prior to your procedure if you are taking:
- Blood thinners (plavix, warfarin, pradaxa etc) or
- Diabetes medications (metformin, insulin etc)
As x-rays are routinely performed during ERCP it is essential you tell your doctor if you could be pregnant, or are allergic to iodine or contrast dye.
Please bring your referral, a full list of your medications and your Medicare card on the day of your procedure.
What happens on the day?
Prior to your ERCP you will be seen briefly by your specialist and anaesthetist, who will discuss your medical history and the procedure. Immediately before the procedure your throat will be sprayed with a local anaesthetic, and a small plastic mouth guard will be placed between your teeth to stop you biting the endoscope. ERCP is performed with you lying on your stomach or left side. You will then be given a light anaesthetic (sedative). While this is not a full anaesthetic, most patients are very comfortable during the procedure and don’t remember anything afterwards. The procedure usually lasts for between 30 and 40 mins.
Are there any risks or side effects?
Overall ERCP is a safe procedure that most patients tolerate extremely well. The most common side effects include mild throat soreness, and abdominal discomfort related to retained air in the stomach. More serious complications can occur which may require hospitalization. These include pancreatitis, infection, bleeding and perforation.
Pancreatitis is the most frequent serious complication, and usually presents as worsening abdominal pain. Mild cases respond well to intravenous fluids and bowel rest over several days, while severe cases can require intensive care admission and can even result in death. The risk of pancreatitis varies widely according to the reason for the ERCP and the types of interventions done during the procedure. Your specialist will have a detailed discussion with you regarding the potential side effects of your procedure.
In a small proportion of cases the procedure cannot be completed successfully due to technical reasons.
What happens after my ERCP?
Following the procedure you will be monitored in the recovery area until most of the sedative medication has worn off. Patients frequently remain in hospital overnight to be watched for potential side effects. If your procedure is only a day case, it is essential that you have a friend or relative take you home and stay with you for several hours. It is strongly recommended that you do not drive, operate machinery or sign legal documents on the same day after the test.
What should I watch out for after my ERCP?
Please contact your Gastroenterologist or your nearest emergency department if you experience any of the following symptoms after your procedure:
- Worsening abdominal pain
- Passing blood or black, tarry bowel actions
- Other symptoms that cause you concern.
Your specialist will discuss having an ERCP with you on the day of your procedure, however if you have any questions or concerns please don’t hesitate to contact us.