Endoscopic Retrograde Colangio-Pancreatography (ERCP)

ERCP is a valuable tool for the diagnosis of many diseases of the pancreas, bile ducts, liver and gallbladder. This highly sophisticated test is used to evaluate the Biliary and pancreatic ductal system. An abnormality suspected by clinical history, blood tests or X-ray can be confirmed and studied in detail. The test requires special endoscopic training, and can be accomplished successfully in a high percentage of patients.

INDICATIONS

• Obstruction of bile flow or jaundice
• Suspected or known pancreatic disease
• To determine the need for surgery and the best

PREPARATION
The stomach must be completely empty, so you should have nothing to eat or drink, including water, from 11 p.m. the evening before the examination or for at least six hours before its performance. Your doctor will be more specific about the time to begin fasting, depending on the time of day your ERCP is scheduled. Follow the Endoscopy check list and the instructions provided for Upper Endoscopy preparation. It is important that your doctor know if you have had any barium X-rays in the past week, as barium may interfere with this test. Please bring your X-rays with you, as they may be important.

PROCEDURE
You will be given medication through a vein to make you relaxed and sleepy, and your throat may be sprayed with local anesthetic. While you are lying in a comfortable position on an X-ray table, the ERCP endoscope will be inserted through the mouth and into the duodenum. The opening from the bile duct and pancreatic duct into the duodenum is identified. A small plastic tube (cannula) is then passed through the endoscope into this opening and directed into the bile duct and/or pancreatic duct. Contrast material (dye) is then injected and X-rays are taken to study the ducts. During the procedure, while X-rays are being taken, you may be asked to change your position.

COMPLICATIONS
ERCP is safe and is associated with very low risk when performed by physicians who have been specially trained and are experienced in this highly specialized procedure. Complications can occur but are uncommon. One possible complication is pancreatitis due to irritation of the pancreatic ducts by the X-ray contrast material. Another possible complication is infection.

Localized irritation of the vein may occur at the site of medication injection. A tender lump develops which may remain for several weeks to several months but goes away eventually.

Other less common risks include perforation (tear) of the bowel, drug reactions, and complications from unrelated diseases such as heart attack or stroke.

Death is extremely rare but remains a remote possibility.