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What Happens During an ERCP Procedure?

Endoscopic retrograde cholangiopancreatography, commonly referred to as ERCP, is a highly sensitive endoscopy procedure used to treat symptoms related to a patient’s bile liver, gallbladder and pancreas—such as pancreatitis (inflammation of the pancreas). The test involves gaining access ducts, which are channels inside organs that allow bodily fluids to travel throughout the body—primarily biliary ducts that channel fluid through the liver and pancreatic ducts that channel fluid through the pancreas.

During an ERCP procedure, the patient is kept under deep sedation, as the test lasts a longer time than other endoscopic tests and is quite sensitive. A long and flexible tubular device called an endoscope is passed through the patient’s mouth, down the esophagus and through the stomach until it reaches a segment of the gastrointestinal (GI) tract called the duodenum, which is the uppermost part of the patient’s small intestine. When the endoscope reaches this area, another plastic device called a catheter is guided through the endoscope and passed through a tiny duct between the liver and pancreas known as the papilla. The catheter is designed to inject a contrast solution into either the pancreas or the liver, which will make those ducts show up very brightly on x-rays and give doctors a clear view of how those organs are functioning. If the patient has pancreatitis, for instance, your doctor will be able to see it on the final x-ray image produced.

Is There Anything I Need to Do to Prepare for ERCP?

Fasting is required for at least 6 hours before undergoing ERCP. The goal is to empty the patient’s stomach so that food content does not obstruct the endoscope’s path or cause distortion during the x-ray. We with any medical procedure, also remember to inform your gastroenterologist (GI doctor) of any allergies you have (especially to sedation medication or contrast material used in prior imaging tests), any medications you are currently taking or any conditions or diseases you may have. Knowing this information will help you and your doctor to minimize risks of the procedure and to decide whether ERCP is the best endoscopy procedure for you.

What Happens After an ERCP Procedure?

Complications after a highly trained professional performs ERCP are pretty uncommon. In some cases, pancreatitis may develop after the ERCP procedure (about a 1% risk), in which case further treatment will need to be implemented. Other post-procedural complications include bleeding and infection. The most dangerous risk—although it is very rare—is perforation (tearing) of bodily tissue. Tearing would require invasive surgery in order to repair the damage and can sometimes lead to organ failure or death. In general, undergoing the procedure for diagnostic reasons is much safer than undergoing the procedure for therapeutic purposes, such as in the case that gallstones need removal.

After the test, you must have someone drive you home, as driving while the sedation medication is still in effect is very unsafe. Patients mostly feel bloated or cramping as a result of air entering the body during the procedure. These symptoms should pass within a few days. You can usually eat regularly after the procedure—but talk to your specific medical provider to be sure.

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