Diagnostic and Treatment Services

ERCP

Endoscopic retrograde cholangiopancreatography, or ERCP, is a gastrointestinal procedure that combines endoscopic and radiologic techniques. It involves passing a long, flexible tube containing a video camera (the endoscope) through the mouth into the intestine, and performing various interventions by introducing fine instruments through the channel of the endoscope.

ERCP is performed by a gastroenterologist in order to diagnose and/or treat a variety of diseases of the pancreas, the bile ducts, the gallbladder and the liver.

It may be required in patients with symptoms such as abdominal pain, jaundice (yellowing of skin and eyes) or weight loss. It is an extremely useful tool in the diagnosis of gallbladder and bile duct stones, chronic pancreatitis, tumors of the pancreas and bile ducts and to investigate bile duct complications of gallbladder surgery and liver transplantation.

The procedure

ERCP procedures are performed at Northwest Community Hospital's Gastroenterology Center, located at the Busse Center for Specialty Medicine on the main campus of Northwest Community Hospital. The procedure rooms are specially equipped to provide both endoscopic monitoring and radiologic imaging.

Initially, our patients are welcomed at the admitting area of the Gastroenterology Center, where our nurses will take a brief history and place an IV in an arm vein. Your doctor discusses the final details and expectations from the procedure and our patients have the opportunity to ask any questions they may have.

Subsequently, the patient is taken to the ERCP procedure room and placed on the procedure table usually facedown with the head turned to the right. A device to protect the teeth is placed in the mouth. Then the IV sedation is administered by an anesthesiologist.

The actual procedure starts with insertion of the endoscope through the patient's mouth and usually lasts less than an hour. It may involve a wide variety of interventions including removal of stones from the bile duct or the pancreas, balloon dilation and/or deployment of stents (small hollow tubes) across bile duct narrowings, diagnostic tissue sampling, etc.

At the end of the procedure, patients are transferred to the recovery area where they usually remain for about an hour after which they are released to go home always in the company of a family member or friend. Some patients may require admission to the hospital usually for a day or two following ERCP depending on the presence of certain symptoms or the complexity of their procedure.

Patient preparation

For most patients, the only requirement prior to the procedure includes avoiding any food or drink for eight hours before the procedure. Additionally, some patients may be required to avoid certain medications for a few days before the procedure.

We will provide you with specific instructions about which medications you may need to avoid.

Risk profile

For most ERCP procedures the risk of a complication is less than 10 percent. The most common adverse effects of ERCP are acute pancreatitis, intestinal bleeding, infection, intestinal perforation and drug reaction.

Acute pancreatitis may occur in 5 percent of ERCP procedures. Some patients are at higher risk for post-ERCP pancreatitis—this will be dicussed prior to the procedure. It involves inflammation of the pancreas which may cause abdominal pain, nausea or vomiting for an average of three or four days. It is treated in hospital with fasting, IV fluids and pain medication. Very rarely it can take a severe, potentially life-threatening course requiring monitoring and treatment in an intensive care unit.

Intestinal bleeding may occur in 1 percent of ERCP procedures, usually the result of a "papillotomy," a tiny internal incision that is performed on the bile duct via the endoscope.

Infection may follow an ERCP procedure that failed to establish the patency of a bile duct that has been obstructed by a stone or a tumor. If you are at risk for infection, your physician will prescribe antibiotics.

Intestinal perforation is a very rare complication occurring in 0.5 percent of ERCP procedures and may also be the result of a "papillotomy." Perforations that occur during ERCP usually do not require surgery to correct.

Drug reactions are rare but may occur in patients with severe heart and/or lung disease or as a result of an allergy to a medication used for sedation.