Endoscopic Retrograde Cholangiopancreatography (ERCP) is an exam that has been used for more than 20 years to diagnose concerns in the pancreas, bile ducts, gallbladder, and liver. It can be completed quickly, requires minimal preparation, and relieves such uncomfortable symptoms as gallstones and abdominal pain. At Bay Area Gastroenterology in Trinity, FL, we regularly perform this exam and know its value in maintaining patient health.
How Is ERCP Performed?
This exam combines an endoscope, a long tube with a light at the end, with X-ray to view the inside of your body and identify problems. The endoscope is remarkably flexible and can easily maneuver around the many bends of the upper gastrointestinal tract.
Regardless of how it is angled, the glass fiber-optic bundle at one end transmits images to the other viewing end. And an open channel in the scope permits instruments to pass through so we can inject solutions, perform biopsies, or remove polyps.
Different Patients Have Different Needs
An ERCP may be done during your stay in the hospital or as an outpatient procedure. While the process may vary slightly based on your health condition, you can generally expect to wear a hospital gown free of jewelry and other objects that may interfere with the X-ray. An IV will be placed in your arm or hand, and you’ll be sedated throughout the procedure.
It’s important to know that a sedative will make you feel relaxed and sleepy but keeps you awake. If we decide it’s best for you to have general anesthesia, you will sleep through the procedure. Rest assured we’ll discuss both options with you and choose the one right for your needs.
Details of the Procedure
Oxygen may be administered through a tube in your nose as you rest. You will need to lie on your left side or belly while on the X-ray table to allow a full view of your ducts. Once you’re relaxed (or asleep), the endoscope is gently guided through your mouth and down the esophagus.
A thin tube is then inserted down the endoscope to the main bile duct that enters the duodenum. Contrast dye is injected into the ducts and X-ray films taken. If necessary, we’ll also take samples of tissue or fluid.
Additional Steps We May Take
You may be asked to change positions at different times so the X-ray can reach the pancreatic duct as well. Depending on what these images reveal, additional steps may be taken. For instance, a gallstone may be removed if it’s found. Or, if a duct has become narrowed, an incision may be made to relieve the blockage. Small tubes may additionally be placed inside the ducts to keep them open.
After the Exam
Once the X-rays have been taken and any other necessary steps completed, the endoscope will be removed. The procedure takes about an hour to complete, after which you’ll be moved to a recovery area. Once your breathing, pulse, and blood pressure are stable and you feel alert, you will be returned to your hospital room or discharged home. If the exam was performed as an outpatient procedure, you will need someone to drive you home.
You will be able to eat and drink once your gag reflex has returned. Unless a member of our staff tells you otherwise, you can immediately return to your normal diet and activities. Many patients spend the rest of the day relaxing at home.
Learning Your Results
You will likely learn the results of your exam on the same day as your procedure. Several days may be needed to receive all the information, especially if we obtained a sample of tissue or fluid. These samples are sent to a lab where professionals examine and test them. We’ll let you know when your lab results have returned and what the findings are.
Preparing for the Test
It’s crucial you avoid drinking or eating for eight hours prior to your scheduled exam time. We may give additional instructions for a special diet to follow one or two days before the test.
You may also be asked to sign a consent form indicating you understand the exam and agree to have it done. Read the details of this form carefully and ask questions if you’re unsure of a specific point. It’s also important to tell us if you:
- Are allergic to iodine
- Previously had a reaction to contrast dye
- Are sensitive or allergic to anesthesia, tape, latex, or certain medications
- Might be pregnant
- Have a history of bleeding disorders
- Currently take blood-thinning medications
- Have heart valve disease
Getting to Know You
During your consultation, we’ll review what you should expect from the ERCP. We’ll also ask questions about any herbal supplements and medicines you currently take, including those purchased over-the-counter. Last but not least, we’ll provide you with all instructions to follow to ensure your exam goes as smoothly as possible.
Reasons to Have This Test
Doctors essentially perform this exam to find and treat problems in the pancreatic and bile ducts. This exam may be recommended if we suspect a disease of the liver or pancreas. This test can also help determine the cause of abnormal results from a CT scan, ultrasound, or blood test. Finally, this procedure can help us decide if surgery is necessary and, if so, which is best for your health needs.
Most people get this exam because they have:
- Unexplained abdominal pain
- Yellow skin or eyes (known as jaundice)
- Light stools
- Dark urine
Before or After Gallbladder Surgery
In certain situations, we may choose to do this test before or after gallbladder surgery to find and remove gallstones. An ERCP can also help locate lesions and guide us in unblocking the bile duct. This duct allows digestive juices to flow properly. Other concerns that may be identified with this procedure include:
- Infections in the bile ducts
- Fluid leaking from the ducts
The Benefits of This Test
This exam can either resolve your pancreatic concerns and alleviate such symptoms as stones, obstructions, and pain or provide evidence that additional therapeutic interventions are necessary. Equally important, this exam can reduce the risk of more serious complications in the future.
Randomized trials prove this procedure can decrease morbidity in certain patients with gallstone pancreatitis. The test is also valuable in finding and treating pancreatic duct leaks. Likewise, in patients with recurring pancreatitis, this exam can identify bile duct concerns not detected by other imaging tools.
The Ability to Make Other Diagnoses
The diagnosis and treatment of pancreatic cancer can be achieved with this test as well. Similarly, we can use the procedure to detect anatomical or physiological abnormalities of the pancreas. To illustrate, pancreas divisum happens when the ducts from the two portions of the pancreas fail to fuse together.
Understanding the Body’s Accessory Organs
The gallbladder, pancreas, and liver are known as accessory organs because they coordinate with the GI tract to break down food. The gallbladder resembles a pouch and stores bile produced by the liver. It shares a vessel with the liver called the common bile duct. Bile travels through this duct into the duodenum, or the first part of the small intestine, to break down fat.
The pancreas sits below the stomach and produces a number of enzymes collectively known as pancreatic juice. This liquid helps neutralize acidic chyme (partly digested food) when it enters the small intestine. Pancreatic juice also helps the body digest carbohydrates, fats, and proteins.
Recognized as the largest gland in the body, the liver is instrumental in many different digestive roles. To illustrate, it:
- Breaks down nutrients
- Stores some vitamins and minerals
- Removes waste and toxins from the body
- Produces bile, a green fluid that breaks down fats
A Comprehensive Look Inside Your Body
An ERCP provides significant information about your accessory organs and the treatment necessary to correct specific maladies. In some situations, therapy can be administered at the same time as the exam. To learn more, contact Bay Area Gastroenterology in Trinity, FL, and schedule your consultation today.