What is an ERCP?
GI Alliance of Illinois performs endoscopic processes to diagnose several types of digestive health conditions. An ERCP, or endoscopic retrograde cholangiopancreatography, is an endoscopic process where a thin, flexible “scope” is positioned into the mouth and gently advanced to the duodenum (or first portion of the small intestine). The tube houses a camera and a light that lets your provider examine the internal tissues of the esophagus, stomach, small intestine, the opening to the bile duct, and the pancreatic duct. An ERCP may be conducted to detect the reason for GI concerns, such as:
- Abnormal x-ray results
- Abdominal pain
- Pancreatitis
- Abnormal liver test
Please contact your nearest location today to request a consultation with a gastroenterology specialist to hear more concerning an ERCP procedure.
What are the benefits of an ERCP?
An ERCP may be necessary if you have abnormal liver results after a blood test, if you’re experiencing inflammation of the pancreas, or if you have issues such as abdominal pain or yellowing of the skin and eyes. Some benefits of an ERCP procedure are:
- Diagnostic and therapeutic: An ERCP can serve dual objectives, helping doctors detect diseases or conditions and conduct treatment within the same process. As such, this can reduce the need for multiple treatment processes.
- Short recovery periods: Patients often have faster recovery periods with an ERCP compared to conventional approaches involving surgery, allowing for a quicker return to daily or routine activities.
- Enhanced precision: An ERCP allows for the precise treatment and visualization of the biliary and pancreatic ducts. This is imperative for accurate diagnosis and treatment of a condition.
- Efficiency: The opportunity to detect and treat a health concern during one procedure commonly reduces the overall treatment time for patients.
How can I prepare for my ERCP procedure?
You will be provided with specific instructions from your provider at GI Alliance of Illinois detailing the steps to take to prepare. In most cases, you will be able to eat as you normally do the day before the test. Patients will be informed not to ingest anything by mouth after midnight with the exception of medications. It is crucial to follow the directions provided to you by your provider. Additional information concerning your medications will be provided. In most circumstances, your medications will be continued as usual. However, in certain cases, like people taking anti-coagulants, (such as warfarin, Plavix®, Coumadin®, aspirin, and anti-inflammatories) and diabetic patients, special instructions will be discussed.
What happens the day of the ERCP exam?
You will be asked to enter the endoscopy center in Illinois 1 – 1.5 hours before your ERCP exam. This time will be used to fill out paperwork and prepare for the assessment. You will then need to put on a medical gown. Our team will place an intravenous (IV) catheter in your arm to prepare for sedation to be administered. We will also utilize equipment to enable your provider and our team to monitor your breathing, oxygen, pulse, blood pressure, heart rate, and electrocardiogram levels throughout the course of and after the procedure.
Upon entering the treatment room, you will then lie down on your stomach on the table. Your IV sedation will then be started. A small dose will be provided at a time to ensure that you do not have a reaction to the medication and to limit it to only the amount you need individually. In comparison with other types of endoscopic evaluations, it is not uncommon for general anesthesia to be used for this procedure. Once a sufficient sedation status is achieved, the endoscope will be introduced into the mouth. It will be carefully forwarded through the esophagus and into the stomach and to where the bile duct and pancreatic duct open into the small intestine. A small amount of air is administered through the scope into the gastrointestinal system to help your provider get a better view. In an ERCP exam, an iodine-based contrast dye is administered into the biliary duct and pancreatic duct. A radiographic (x-ray) imaging machine is used to capture clear pictures of the biliary and pancreatic ducts to identify whether there are any concerns or abnormalities. Any residual fluid in the upper gastrointestinal tract can be removed through the scope device. Depending on any discoveries, a number of things could be carried out during the course of the evaluation, including tissue biopsies, removal of gallstones from the bile ducts or stones from the pancreatic ducts, stent placement (plastic/metal tubes) into the bile duct or pancreatic duct, and sphincterotomy (opening the bile duct or pancreatic duct). When the procedure is complete, as much of the air and remaining fluid as possible will be suctioned out via the endoscope device. The ERCP evaluation takes approximately 30 – 90 minutes to perform depending on the findings.
Once the evaluation is complete, you will be taken to the recovery room to be monitored while the sedative effects begin to fade away. The portion of sedation provided throughout the ERCP procedure and how your body responds to the medication will affect how fast you wake up, but most patients are awake enough for release within 45 – 60 minutes. You will not be able to drive for the remainder of the day and will, therefore, need to arrange for a ride home in advance. You will also be instructed not to work, perform strenuous activities, or sign important papers for the remainder of the day. In most situations, people can drink and eat as usual following discharge from the endoscopy unit, though pertinent instructions concerning activity, medications, and eating will be given before dismissal. There may be times when ERCP patients might be admitted to stay in the hospital overnight for assessment or monitoring.
What are the risks of an ERCP?
Endoscopic retrograde cholangiopancreatography, in general, is regarded as a very safe test. In most situations, any complications that develop are not life-threatening, however, should a complication arise, it may lead to surgery and hospitalization. Before the assessment, a consent to treat form will be reviewed and discussed with the patient by the clinical team. Treatment risks will again be discussed by the doctor before the ERCP test gets underway, and any concerns or questions can be addressed.
Acute pancreatitis is the most prevalent complication. It may arise in 5 – 8 percent of individuals, though, depending on individual factors, the risk can be as high as 20 percent. Indications of pancreatitis can include abdominal pain, nausea, vomiting, and possibly fever. Most cases of pancreatitis are not severe and require four or fewer days in the hospital. While in the hospital, patients typically only require nausea and pain control along with IV fluids. Rarely, however, pancreatitis can be more severe and life-threatening.
Medication reactions from the sedation can arise. These reactions can include but are not limited to, difficulty breathing, effects on blood pressure and the heart, irritation of the vessel used to administer the sedative, and allergic reactions. Bleeding can be a result of biopsies or a sphincterotomy. Again, significant bleeding which may indicate a blood transfusion, or hospitalization, is not common.
Perforation or piercing of the small bowel, stomach, or esophagus can result. Such an event may not be detected at some point during the exam, or it may not be apparent until later. The majority of the time, a perforation will lead to a hospital stay and surgery. This is still a very uncommon complication, even when biopsies, or a sphincterotomy, are performed.
In addition, in 5 – 10 percent of patients, the procedure might not be able to be carried out for a variety of reasons. It is extremely crucial that the patient contact the doctor’s office right away should any symptoms become noticeable following the procedure, such as increasing abdominal pain, bleeding, or fever.
The same as with any other procedure, endoscopic retrograde cholangiopancreatography is not flawless. There exists a slight, understood risk that diseases, including cancers, can be missed with the procedure. It is crucial to continually visit your physicians as instructed and inform them of any new or ongoing symptoms or issues.
Should you need to have an ERCP in Illinois, our GI doctors can help you choose the optimal solution for your medical needs.
