What is endoscopic retrograde cholangiopancreatography (ERCP)?
Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure for the examination and to perform therapies within the ducts or “drainage tubes” of the gallbladder, pancreas, and liver. This procedure may be performed for the removal of bile duct stones or in patients with jaundice secondary to bile duct strictures or “blockages” and is usually performed by a Gastroenterologist with expertise in interventional endoscopy.
How do I prepare for an ERCP?
An empty stomach is essential for a safe procedure, so you should have nothing to eat for six hours beforehand. You can continue to drink ‘clear fluids’ only (i.e. water, clear fruit juice without pulp, cordial, black tea/coffee WITHOUT milk, Gatorade/sports drinks, soft drinks) up until two hours prior to your procedure. After that you must remain nil by mouth apart from a sip of water with any important regular medicines (but do not take any diabetes medications).
Patients taking diabetic or blood thinning medications should inform their Gastroenterologist as they may require specific instructions. X-rays are required during the procedure so it is important to tell your doctor if you could be pregnant.
How is an ERCP performed?
Deep sedation or general anaesthesia is administered by an anaesthetist prior to your procedure so that you are comfortable. Once sedated and lying comfortably on your stomach, a duodenoscope (a flexible tube with a camera on the side of the distal end) is passed through your mouth and into the oesophagus, stomach and duodenum, where the bile duct and pancreatic duct drain into the small bowel. A small plastic instrument is then passed through the duodenoscope into the bile duct and/or pancreatic duct and using contrast dye, an x-ray image of the ducts is obtained. Sometimes a small cut is made at the opening of the bile duct (“sphincterotomy”) to facilitate the removal of stones or to place a stent (i.e. drainage tube). The procedure usually takes between 30 and 60 minutes to complete.
What happens after an ERCP?
Following the procedure, you will remain in the recovery area for an hour or so until the sedation medication wears off. You will usually be allowed to commence fluids to drink once you are awake, but solids are usually recommenced the following day. Your Gastroenterologist will briefly inform you of your test results on the day of the procedure and if necessary, a follow-up appointment may be made to discuss the test results in more detail.
Because of the sedation medication given during the procedure, it is very important that you do not drive a car, travel on public transport alone, operate machinery, sign legal documents or drink alcohol within the first 24 hours after the procedure. After 24 hours you can return to work and resume normal activities. It is mandatory that a responsible adult accompanies you home after the procedure and stays with you overnight.
What are the risks or side-effects?
ERCP is an advanced endoscopic procedure for therapies within the bile duct and/or pancreatic duct and therefore the risk of complications is higher than for diagnostic endoscopic procedures. The procedure cannot be successfully completed for technical reasons in approximately 5-10% and repeat attempts or alternative procedures may be necessary. Common side-effects may include a mild sore throat and abdominal discomfort which should resolve within a few hours. The risk of pancreatitis (inflammation of the pancreas) is approximately 3-5% but may be higher (up to 15%) in selected patients. If this occurs hospital admission will be required and admission to an intensive care unit may be required in severe cases (0.3-0.5%). Bleeding occurs in approximately 1-2% and may require blood transfusion or repeat endoscopy. The risk of infection is estimated at 1-2% and the risk of cardiopulmonary complications is estimated at 1%. The risk of perforation (hole in the wall of the bowel) is up to 0.6%, which if recognized during the procedure may be successfully managed endoscopically, otherwise surgery may be required. Like all medical procedures, there is a remote chance that a significant complication can result in death, however this is rare (3 in 1,000 cases) following ERCP.