Endoscopic Retrograde Cholangiopancreatography (ERCP)

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Image courtesy of Shawn Mallery, MD & Minnesota Pancreas and Liver Center

What is endoscopic retrograde cholangiopancreatography (ERCP)?
Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to image the digestive tract, including the pancreas.  A special, thin, lighted tube, called an endoscope, is guided through the patient’s mouth, down through the stomach, and into the first part of the small intestine, called the duodenum.  A narrower plastic tube, called a catheter, is inserted through the endoscope into the bile and pancreatic ducts from the small intestine.  A contrast dye is injected through the catheter into the ducts and an x-ray picture is taken.

Why is ERCP used?
ERCP can provide important diagnostic information to the doctor.  Biopsies, or samples of the tumor, can be obtained during ERCP.  The pictures taken during an ERCP procedure allow the doctor to see if the pancreatic or bile ducts are narrowed or blocked by a tumor or other condition.

An ERCP can also be used to guide treatment options in situations where the bile duct is blocked by the cancer resulting in jaundice, a yellowing of the skin and eyes.  Surgeons can use the information to determine whether surgery is necessary or help to plan for surgery.  During the ERCP, a small plastic or metal tube, called a stent, can be placed into a blocked bile duct to keep it open and allow bile to flow.  Stent placement during an ERCP is the preferred method of treating jaundice caused by a blockage of the bile duct as it is much less invasive than surgical treatment.

What happens during an ERCP?
During an ERCP, the patient lies on his/her side and the doctor passes the endoscope through the mouth, esophagus and stomach and into the duodenum.  The tube will not affect the patient’s ability to breathe normally.

Then, a small catheter known as a cannula is passed from the endoscope into the pancreatic or biliary ducts.  Contrast dye is injected through the cannula into the ducts and x-rays are taken.  The x-ray images are pictures of the dye outlining the ducts, so that widening, narrowing, or blockage of the ducts can be seen.

Usually the ERCP procedure lasts 30 to 90 minutes and is considered by most patients to be mildly uncomfortable.

What should I do to prepare for an ERCP?
The healthcare team will give the patient exact instructions before an ERCP procedure.  In general, the patient will not be allowed to eat or drink anything six hours before the examination.  Some patients receive antibiotics before the procedure to avoid infection.  The doctor will tell the patient whether to continue taking these or other medications before the ERCP procedure.

Patients are given a sedative to help them relax and an anesthetic drug to block pain.  ERCP is performed under heavy conscious sedation so the patient may feel drowsy, but will be awake during the procedure.

Just before the ERCP, the patient will receive sedative medication through a vein in the arm and local anesthetic spray to the throat, in order to be comfortable during the procedure.  Since sedative medications are used, the patient should prepare in advance to have someone else drive him/her home after the procedure.

What can I expect after an ERCP?
After the ERCP procedure is completed, the patient will remain in the recovery room until the sedative medication has worn off.  The patient should not drive a vehicle after receiving sedative medication.  It is not unusual for the patient to experience a feeling of fullness or the need to pass gas after the procedure.  Also, the patient may have changes in bowel habits, for instance, soft stool, after the procedure.  The healthcare team will provide instructions regarding eating and drinking following an ERCP procedure.

Image courtesy of Shawn Mallery, MD & Minnesota Pancreas and Liver Center

What complications can occur with an ERCP?
Complications from ERCP are uncommon.  Approximately 5-7% of patients experience inflammation of the pancreas, called pancreatitis, as a complication of ERCP.  Often the pancreatitis is mild, but serious pancreatitis can occur.  Gastrointestinal bleeding, tearing from the endoscope, allergic reactions to anesthesia medications, and infection are other rare complications of ERCP.  Sometimes, patients are admitted to the hospital for one night for observation after the ERCP procedure.

Where would I go for an ERCP procedure?
ERCP is usually performed in a hospital endoscopy unit or ambulatory surgery center.  It is an outpatient procedure, so patients do not have to stay overnight in the hospital.

How does ERCP compare with other techniques used to image the pancreas?
ERCP is generally performed when other tests fail to detect pancreatic lesions or when symptoms of jaundice are present.  If a stent is not needed to alleviate jaundice, the less invasive imaging procedure called magnetic resonance cholangiopancreatography (MRCP) may be used in place of ERCP for diagnostic purposes.  If images of only the bile ducts, not pancreatic ducts are wanted, a percutaneous transhepatic cholangiography (PTC) may be used.

Other Resources:
American Gastroenterological Association (AGA)
American Society of Gastrointestinal Endoscopy (ASGE)

For more information about jaundice, stents or other the other imaging tests mentioned above, contact a Patient and Liaison Services (PALS) Associate toll free at 877-272-6226 or email pals@pancan.org.  PALS Associates are available M-F 7am-5pm Pacific Time.


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