ERCP (Endoscopic Retrograde Cholangio-Pancreatography)

  • Medical Author:
    Jay W. Marks, MD

    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.

  • Medical Editor: Bhupinder Anand, MD
woman with abdominal pain

What kind of preparation is required for ERCP?

For the best possible examination, the stomach must be empty. The patient should not eat anything after midnight on the evening preceding the exam. In case the procedure is performed early in the morning, no liquids should be taken. In case the examination is performed at noon time, a cup of tea, juice, milk, or coffee can be taken four hours earlier. Heart and blood pressure medications should always be taken with a small amount of water in the early morning. Since the procedure will require intravenous sedation, the patient needs to have a companion drive them home after the procedure.

What can be expected during and after the ERCP procedure?

The patient will be given medications through a vein to cause relaxation and sleepiness. The patient will be given some local anesthetic to decrease the gag reflex. Some physicians do not use local anesthetic and prefer to give the patients more intravenous medications for sedation. This also applies to those patients who have a history of allergy to Xylocaine or cannot tolerate the bitter taste of the local anesthetic and the numbness sensation in the throat. While the patient is lying on the left side on the X-ray table, the intravenous medication is given, and then the instrument is inserted gently through the mouth into the duodenum. The instrument advances through the food pipe and not the air pipe. It does not interfere with the breathing and gagging is usually prevented or decreased by the medication.

When the patient is in  a semi-conscious state, they can still follow instructions such as changing the body position on the X-ray table. Once the instrument has been advanced into the stomach, there is minimal discomfort except for the foreign body sensation in the throat. The procedure can last anywhere from fifteen minutes to one hour, depending on the skill of the physician, what needs to be accomplished, and the anatomy or abnormalities in that area. ERCP also may be performed under light, general anesthesia.

After the procedure, patients should be observed in the recovery area until most of the effects from the medications have worn off. This usually takes one to two hours. The patient may feel bloated or slightly nauseated from the medications or the procedure. Very rarely a patient experiences vomiting, and may belch or pass some gas through the rectum. Upon discharge, the patient should be driven home by a companion and is advised to stay home for the rest of the day. The patient can resume usual activity the next day. Even though the physician may explain he findings to the patient or companion after the procedure, it is still necessary to follow up with the physician after the procedure to ensure that the patient understands the results of the examination.

Medically Reviewed by a Doctor on 3/9/2016

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