ERCP is a procedure conducted when a disorder of the bile ducts or pancreatic ducts is suspected. It combines upper gastrointestinal endoscopy and X-rays (fluoroscopy) to view, diagnose and treat obstructions and illnesses. An endoscope is a thin, flexible tube outfitted with a light and miniature camera.
ERCP is minimally invasive and is conducted either in a hospital or an outpatient treatment center.
What is Bile?
Bile is a greenish-yellow digestive fluid manufactured in the liver and accumulated in the gallbladder. As you eat, bile travels to the liver via a bile duct. The duct connects your gallbladder and liver to your small intestine (duodenum).
Bile breaks down fat into fatty acids so that they can be absorbed during digestion. It also enables the digestion of fat-soluble vitamins D, K, A, and E. Bile removes waste such as cholesterol and hemoglobin from damaged red blood cells.
What is a Pancreatic Duct?
Pancreatic ducts transport digestive juices from your pancreas to your duodenum. Your main pancreatic duct and your common bile duct merge like branches of a river, and their content flows into your small intestine.
Why is an ERCP Done?
This procedure is done for several reasons, including:
- Fluid leaking from the bile ducts or pancreatic ducts.
- Blocks or constriction of the pancreatic ducts.
- Gallstones that get stuck in your bile duct.
- Scarring of the ducts (sclerosis).
- Valves (sphincters) that won’t open properly.
- A buildup of fluid and tissue (pseudocysts).
- Bile duct infection.
- Undiagnosed abdominal pain.
- Dark urine.
- Jaundice (a condition that turns your skin and the whites of your eyes yellow).
The procedure can also be done to follow up on an abnormal MRI, ultrasound, or CT scan.
How Do I Prepare for an ERCP?
Although your doctor will have specific instructions for you, you’ll generally need to:
- Stop eating and drinking at least eight hours before your surgery so that your doctor has a clear view of your digestive tract. You may also be asked to abstain from smoking or chewing gum.
- Temporarily stop anticoagulants such as aspirin, ibuprofen, and warfarin. You may also be asked to temporarily forgo antidepressants, diabetes medications, vitamins, and herbal supplements.
- Arrange for a ride home while the sedative wears off. We will not perform the procedure if you don’t have transportation. You shouldn’t drive for 12 to 24 hours after surgery because your judgment and reaction time will be impaired.
What Happens During ERCP Surgery?
First, you’ll gargle with an anesthetic or have one sprayed in your throat. This will numb your throat to ease your gag reflex. Next, you’ll intravenously receive a sedative to keep you relaxed. General anesthesia may also be an option.
Then, you’ll lie on your side or back on an X-ray table. A guard will be placed in your mouth to prevent you from biting the endoscope and to protect your teeth and mouth.
Next, your doctor will guide an endoscope through your esophagus, stomach, and small intestine until it arrives at your bile ducts. Air may be blown into the area to enlarge it for easier viewing. This may make your abdomen feel bloated.
Then a contrast medium is released into the ducts, and a particular type of X-ray imaging called fluoroscopy is done. A contrast medium is a dye that accentuates specific internal organs to be more easily seen and studied.
Don’t worry, though. It won’t permanently color your bones, organs, or tissues. It will be eliminated in your urine and bowel movements.
After the bile duct has been examined, the endoscope is adjusted to face the pancreatic ducts, and the procedure is repeated.
Video from the endoscope’s camera is transmitted in real-time to a computer screen for your doctor’s evaluation.
It’s also possible for small tools to be sent through the endoscope to:
- Break up or remove stones.
- Perform a biopsy. Brush cytology is a type of biopsy that enables your doctor to remove tissue from inside the ducts with a brush-like apparatus that attaches to the endoscope. The cells are then analyzed for abnormalities.
- Remove tumors from the ducts.
- Insert stents. These are small tubes inserted into narrow ducts so that they stay open. Temporary stents can also be used to stop bile leaks.
Other procedures may also be done at this time, including removal of tissue, fluid samples, gallstones, or various obstructions.
ERCP can take anywhere from 30 minutes to two hours. This depends upon the extent of the procedures your doctor performs.
What Happens After ERCP?
After ERCP, you will spend 1 to 2 hours in a recovery room to make sure you are alright. Your blood pressure, pulse, and breathing will be monitored to ensure they are stable. Your throat may be sore for a day or two, making swallowing uncomfortable, and you could briefly experience bloating and nausea.
You may need to be hospitalized overnight, and your doctor will determine if this is necessary. Until your gag reflex resumes, you won’t be permitted to eat or drink anything. Your doctor will also let you know if you can resume eating your normal diet and taking your regular medications.
When Will I Get My Results?
Typically, your ERCP results will be ready the same day as your procedure. If your doctor did a biopsy, which is removing a small tissue sample, the results may take longer.
When is an ERCP Not Recommended?
You may not be a candidate for this procedure if:
- You’ve recently had a barium enema or a barium swallow and still have the substance in your body.
- Your bile ducts have been blocked by gastrointestinal surgery.
- Your esophagus contains pouches, abnormalities, or other conditions that would make it impossible to feed an endoscope through your throat.
One of the biggest benefits of ERCP is that it may help you avoid major surgery while still producing optimal results. It can often be done as an outpatient procedure with minimal recovery time.
Contact us today! The team of professionals at GastroMD looks forward to working with you. We are one of the leading gastroenterology practices in the Tampa Bay area. We perform a host of diagnostic procedures using state-of-the-art equipment in a friendly, comfortable, and inviting atmosphere where patient care is always a top priority