Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
The health care provider usually provides written instructions about how to prepare for ERCP.
The upper GI tract must be empty. Generally, no eating or drinking is allowed 8 hours before ERCP. Smoking and chewing gum are also prohibited during this time.
Patients should tell their health care provider about all health conditions they have, especially heart and lung problems, diabetes, and allergies. Patients should also tell their health care provider about all medications they take. Patients may be asked to temporarily stop taking medications that affect blood clotting or interact with sedatives, which are usually given during ERCP to help patients relax and stay comfortable.
Medications and vitamins that may be restricted before and after ERCP include
nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil), and naproxen (Aleve)
blood thinners
high blood pressure medication
diabetes medications
antidepressants
dietary supplements
Driving is not permitted for 12 to 24 hours after ERCP to allow the sedatives time to completely wear off. Before the appointment, patients should make plans for a ride home.
ERCP is a diagnostic procedure designed to examine diseases of the liver, bile ducts and pancreas.
ERCP is performed under intravenous sedation, usually without general anesthesia.
ERCP is an uncomfortable but not painful procedure. There is a low incidence of complications.
ERCP can provide important information that cannot be obtained by other diagnostic examinations, for example, abdominal ultrasound, CT scan, or MRI.
Frequently, therapeutic measures can be performed at the time of ERCP to remove stones in the bile ducts or to relieve obstruction of the bile ducts.
What is ERCP?
Endoscopic retrograde cholangio-pancreatography (ERCP) is a diagnostic test to examine:
the duodenum (the first portion of the small intestine),
the papilla of Vater (a small nipple-like structure with openings leading to the bile ducts and the pancreatic duct),
the bile ducts, and
the gallbladder and the pancreatic duct.
The procedure is performed by using a long, flexible, viewing instrument (a duodenoscope) about the diameter of a pen. The duodenoscope can be directed and moved around the many bends of the stomach and duodenum. The modern videoduodenoscope uses a thin fiber-optic bundle to transmit light to the tip of the endoscope, and a thin wire with a chip also at the tip of the endoscope to transmit digital video images to a TV screen. The duodenoscope is inserted through the mouth, to the back of the throat, down the food pipe (esophagus), through the stomach and into the duodenum. Once the papilla of Vater is identified, a small plastic catheter (cannula) is passed through an open channel of the endoscope into the openings of the papilla, and into the bile ducts and/or the pancreatic duct. Contrast material (dye) is then injected and
X-rays are taken of the bile ducts and the pancreatic duct. An open channel in the endoscope also allows other instruments to be passed through it in order to perform biopsies, to insert plastic or metal tubing to relieve obstruction of the bile ducts caused by cancer or scarring, and to perform incisions by using electrocautery
(electric heat).
The liver is a large solid organ located beneath the right diaphragm. The liver produces bile, which is stored in the gallbladder (a small sac located beneath the liver). After meals, the gallbladder contracts and empties the bile through the cystic duct, into the bile ducts, through the papilla of Vater, and into the intestine to help with digestion. The pancreas is located behind the stomach. It produces a digestive juice that drains through the pancreatic duct--which usually joins the bile duct within the papilla,--and then enters the intestine.
An important procedure related to ERCP is endoscopic ultrasonography which uses a similar endoscope that, in addition to the camera, has an ultrasound probe on its tip to examine the bile ducts, gallbladder, pancreatic duct, and pancreas ultrasonographically. Ultrasonographically-directed needle biopsies of the pancreas can be taken through a channel in the endoscope.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
Pancreatitis is a rare disease in which the pancreas becomes inflamed, occurring when digestive enzymes are activated and begin attacking the pancreas causing damage to the gland. There are two types of pancreatitis, acute and chronic. Most commonly caused by alcohol or gallstones, it can lead to bleeding in the gland, serious tissue damage, infection, and cysts. Enzymes and toxins may then enter the bloodstream and seriously injure organs, such as the heart, lungs, and kidney.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Gallbladder cancer is a rare form of cancer with symptoms that include jaundice, abdominal pain, fever, nausea and vomiting, abdominal lumps, and bloating. Risk factors include being female and Native American. Treatment of gallbladder cancer depends upon the stage of the cancer, the type of gallbladder cancer, and whether the cancer can be removed by surgery.
Primary sclerosing cholangitis (PSC) is a chronic, progressive disease of the bile ducts that channel bile from the liver into the intestines. There is an association between primary sclerosing cholangitis and ulcerative colitis and Crohn's disease. Symptoms of primary sclerosing cholangitis include abnormal liver blood tests, itching, fatigue, and jaundice. Primary sclerosing cholangitis is treated with medications and in some cases, liver transplant.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Pancreas divisum is a common congenital anomaly (an anomaly that is present at birth) of the pancreatic duct(s). The human embryo starts life with two ducts in the pancreas; the ventral duct and the dorsal duct. In more than 90% of the embryos, the dorsal and the ventral ducts will fuse to form one main pancreatic duct. In approximately 10% of embryos, the dorsal and the ventral ducts fail to fuse. Failure of the ventral and the dorsal pancreatic ducts to fuse is called pancreas divisum (because the pancreas is drained by two ducts). In pancreas divisum, the ventral duct drains into the major papilla, while the dorsal duct drains into a separate minor papilla. The majority of individuals born with pancreas divisum experience no symptoms throughout life, will remain undiagnosed and will not require treatment. A small number of patients with pancreas divisum will experience repeated episodes of pancreatitis.
Primary sclerosing cholangitis (PSC) is a chronic (lasting years and
decades), progressive (worsening over time) disease of the bile ducts that
channel bile from the liver into the intestines.
The liver performs many functions; one of them is manufacturing bile. Bile is
a watery liquid made by the cells of the liver that is important for digesting
food in the intestine, particularly fat, and ridding the body of toxins. Liver
cells secrete the bile they make into small canals within the liver. The bile
flows through the canals and into larger collecting canals (ducts) within the
liver (the intrahepatic bile ducts). The bile then flows within the intrahepatic
bile ducts out of the liver and into the extrahepatic bile ducts. From the
extrahepatic bile ducts, the bile flows into the intestine where the bile mixes
with food.
In primary sclerosing cholangitis, the intrahepatic and extrahepatic bi...
