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Endoscopic retrograde cholangiopancreatography (ERCP)

An endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines the use of an endoscopeendoscopeA thin, tube-like instrument with a light and lens used to examine or treat organs or structures in the body. (a thin, lighted flexible tube) and x-rays to examine the ducts that drain the pancreas, liver and gallbladder.

Why an ERCP is done

An ERCP may be done to:

  • look for the cause of constant abdominal pain or jaundicejaundiceA condition in which the skin and whites of the eyes become yellow and urine is dark yellow.
  • find or remove gallstones from the bile duct
  • open a narrowed duct by inserting a stent (small tube)
  • take a biopsy (a sample of tissue for examination under a microscope)
  • diagnose diseases of the pancreas, liver, gallbladder and bile ducts, such as inflammation, infection or cancer

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How an ERCP is done

ERCP is usually done as an outpatient procedure in the x-ray department of a hospital. An ERCP usually takes 30–60 minutes, followed by 1–2 hours in the recovery room.

  • Preparation for an ERCP can vary but usually includes no eating or drinking for 8 hours before the procedure.
  • The person will be asked to remove clothing, jewellery and other objects that will be in the x-ray field and may interfere with the quality of the x-ray.
  • The person will be asked to empty the bladder.

During the ERCP:

  • The person lies on the stomach or left side.
  • An anesthetic spray, gargle or lozenge may be given to numb the throat. This will relax the gag reflex, which makes it easier to put in the endoscope.
  • An intravenous line will be placed in the arm so that medications, including sedation, pain medication and antibiotics, can be given during the procedure.
  • The endoscope is guided into the mouth, passed down the throat, through the esophagus and stomach and into the duodenum (first part of the small intestine).
    • The person may be asked to swallow to help move the endoscope along.
    • A feeling of not being able to breathe is a false sensation caused by the anesthetic. There is enough breathing space around the tube. It is important to relax and take slow, deep breaths during the procedure.
  • The doctor looks at the esophagus, stomach and duodenum as the endoscope is inserted.
  • When the endoscope reaches the duodenum, the doctor identifies the openings where the bile duct and the pancreatic duct drain into the duodenum.
  • A small amount of air is injected through the scope, which makes it easier for the doctor to see the ducts.
  • A small tube is passed through the endoscope to inject contrast mediumcontrast mediumA substance used in some diagnostic procedures to help parts of the body show up better on x-rays or other imaging tests. into the ducts. A flushing sensation may take place when the contrast material in injected.
  • X-rays are taken.
  • Special instruments may be passed through the endoscope during ERCP.
    • A small brush or forceps may be used to remove cells or a tissue sample.
    • If doctors find a gallstone, they can remove it in some cases.
    • A small mesh or plastic tube (called a stent) can be inserted through the endoscope to hold open a narrowed bile duct.
  • The endoscope is slowly removed when the procedure is finished.
    • The person may gag, feel nauseous or have bloating or mild abdominal cramping during removal of the endoscope.

After ERCP:

  • The person cannot eat or drink until the throat is no longer numb and the person can swallow without choking.
  • Driving is not allowed for 24 hours.
  • The person should not return to work for 24 hours.
  • The person may have gas and feel bloated.
  • The person may have a mild sore throat, hoarseness or throat irritation.
  • If gallstones are removed or a stent is inserted, the person may have to stay in hospital overnight.

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Potential side effects

Potential side effects of having an ERCP may include:

  • inflammation of the pancreas
  • bleeding, which may occur if the ducts are enlarged or if biopsies are taken
  • infection of the bile ducts, which may occur if gallstones were removed
  • reaction to the anesthesia, dye or drug used during the procedure, which can cause:
    • blurred vision
    • breathing problems
    • dry mouth
    • burning or flushing feeling
    • hives
    • low blood pressure
    • nausea
    • throat spasm
    • urine retention
  • puncture of the esophagus, stomach, duodenum, bile duct or pancreatic duct, which will require surgery to repair

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What the results mean

An ERCP can show:

  • changes in the structure and size of the bile ducts, pancreatic ducts and gallbladder
  • abnormalities of the esophagus, stomach and duodenum
  • narrow or blocked bile or pancreatic ducts
  • inflammation, ulcers, infection or cancer of the esophagus, stomach, duodenum, gallbladder or pancreas

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What happens if a change or abnormality is found

The doctor will decide whether further tests, procedures, follow-up care or additional treatment is needed.

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