Endoscopic Retrograde Cholangiopancreatogram (ERCP)

Test Overview

An endoscopic retrograde cholangiopancreatogram (ERCP) test checks the tubes (ducts) that drain the liver, gallbladder, and pancreas. A flexible, lighted scope (endoscope) and X-ray pictures are used.

The scope is put through the mouth and gently moved down the throat. It goes through your esophagus, stomach, and duodenum until it reaches the point where the ducts from the pancreas and gallbladder drain into the duodenum. A dye is put into the ducts, and X-rays are then taken.

ERCP can diagnose and treat certain problems found during the test. In some cases, your doctor can insert small tools through the scope to:

• Take a sample of tissue (biopsy) from an abnormal growth. Then it can be checked for problems.
• Remove a gallstone in the common bile duct.
• Open a narrowed bile duct. The duct can be opened by inserting a small wire-mesh or plastic tube (called a stent) into it.

Why It Is Done

ERCP is done to:

• Find gallstones or diseases of the liver, bile ducts, or pancreas.
• Remove gallstones from the common bile duct if they are causing problems. These may include a blockage (obstruction), inflammation or infection of the common bile duct (cholangitis), or pancreatitis.
• Open a narrowed bile duct or insert a drain.
• Get a tissue sample for more testing (biopsy).
• Measure the pressure inside the bile ducts (manometry).

How To Prepare

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• You may need to stop eating and drinking before the day of the procedure. If this is the case, your doctor will tell you what to do.
• If your doctor prescribed antibiotics before the test, take them as directed. You need to take the full course of antibiotics.
• Tell your doctor if you are allergic to any dyes, including iodine.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don't have one, you may want to prepare one. It lets others know your health care wishes. It's a good thing to have before any type of surgery or procedure.

How It Is Done

This test can be done in the hospital, an endoscopy center, or a surgery center. You may have to stay overnight if your doctor takes out gallstones or places a stent during the test. Otherwise, you can go home after the test.

Your throat may be numbed with an anesthetic spray, gargle, or lozenge to relax your gag reflex. This makes it easier to insert a thin, flexible fiber-optic endoscope (scope). Shortly before the test begins, an intravenous (I.V.) line will be placed in a vein in your arm. You will get pain medicine and a sedative through the I.V. during the test. You may also get an antibiotic through the I.V.

You will need to lie on your left side. Your head will be tilted slightly forward. A mouth guard may be inserted to protect your teeth from the scope. The scope's tip will be lubricated. The doctor will guide it into your mouth while gently pressing your tongue out of the way. You may be asked to swallow to help move the tube along. The scope is no thicker than many foods you swallow.

When the scope is in your esophagus, your head will be tilted upright to help the scope slide down. Then your doctor will slowly move the scope into your stomach and duodenum. Your doctor looks at all three of these areas as the scope moves forward. When it reaches your duodenum, you will be turned over to lie flat on your belly.

A small amount of air will be injected through the scope. This makes it easier for the doctor to see. The doctor will move the scope forward until it reaches the point where the ducts from the pancreas and gallbladder drain into the duodenum. A thin tube called a catheter is then passed through the scope into that area. Then contrast material is injected into the bile or pancreatic ducts. Several X-rays are taken. You will stay on your belly until the X-rays are ready to view. If needed, the doctor may take more X-rays.

The doctor may insert small tools through the scope. This allows the doctor to take a tissue sample, remove a gallstone, open a narrowed bile duct, or place a stent.

When the test is done, the scope is slowly withdrawn.

After the test

After the test, you will be observed in a recovery room. If your throat was numbed before the test, you will not be allowed to eat or drink until your throat is no longer numb. You will need to be able to swallow without choking. You can then eat and drink normally.

If your doctor removed a gallstone or placed a stent during the test, you may need to stay a night in the hospital. You cannot drive or return to work for 24 hours.

How long the test takes

An ERCP usually takes 30 to 60 minutes.

How It Feels

You may notice a brief, sharp burning or stinging when the I.V. is started in your arm. The local anesthetic sprayed into your throat usually tastes slightly bitter. It will make your tongue and throat feel numb and swollen. Some people report feeling as though they can't breathe sometimes because of the tube in their throat. This is a false sensation caused by the anesthetic. There is always plenty of breathing space around the tube in your mouth and throat. Remember to relax and take slow, deep breaths.

You may gag, feel nauseated or bloated, or have mild belly cramps as the tube is moved. If the discomfort is severe, alert your doctor with an agreed-upon signal or tap on the arm. Even though you won't be able to talk during the test, you can still communicate.

The I.V. medicines will make you feel sleepy. You may not be able to remember much of what happens during or for several hours after the test. You may have heavy eyelids, trouble speaking, a dry mouth, or blurred vision for several hours after the test.

You may feel flushed when the contrast material is injected.

Risks

Complications aren't common. But having this test may cause serious problems, such as:

• Inflammation of the pancreas. (This is called pancreatitis.)
• Bleeding. This may occur if the pancreatic or bile ducts were widened, if a stent was placed, or if biopsies were taken.
• Infection of the bile ducts, which may occur if gallstones were removed.
• Infection of the blood. (This is called sepsis.)
• An abnormal heart rhythm.
• A puncture of the esophagus, stomach, duodenum, bile duct, or pancreatic duct. If this happens, you will need to have surgery to repair the puncture.
• Problems caused by anesthesia.

People who have serious heart disease and older adults who have other chronic diseases have a greater chance of having problems from this test. Talk to your doctor about your specific risks.

Results

Your doctor may be able to tell you about some findings right after the test. But the medicines used to relax you for the test may impair your memory. So your doctor may tell you to call the next day for your results.

Endoscopic retrograde cholangiopancreatogram (ERCP)

Normal:	Contrast material shows normal structure and size of the bile ducts and the ducts that drain the liver, gallbladder, and pancreas. The esophagus, stomach, and duodenum look normal. Pressure in the ducts is normal.
Abnormal:	The ducts are narrowed or blocked. This may be caused by gallstones, scar tissue, inflammation, or cancer. Inflammation, ulcers, or infection are seen. Cancer of the esophagus, stomach, duodenum, gallbladder, or pancreas is found. Pressure in the ducts is not normal.