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.
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
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.
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)
high blood pressure medication
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.