Endoscopic Retrograde Cholangiopancreatography (ERCP)
What is an ERCP?
Your doctor has requested an endoscopic (endoh-SCOP-ik) retrograde cholangiopancreatography (ko-LAN-jee-oh-pan-kree-ah-TOG-ruh-fee), or ERCP, for you. This test uses a flexible, telescope-like instrument called an endoscope to take x-ray pictures of the ducts that drain your liver (bile ducts) and pancreas (see diagram below). This procedure is used to detect any abnormalities in these ducts, such as gallstones or blockages, strictures (narrowing), tumors, or cysts.
Other procedures may be performed while the endoscope is in your duodenum (doo-ODD-uh-num), which is the first part of your small intestine. These procedures may include stretching or enlarging a narrowed duct; removing blockages, like gallstones; or taking cell samples for further study.
How do I prepare for the test?
The following are general guidelines for this test. You will receive more specific instructions from your doctor, nurse, or testing center.
Please check with your doctor or testing center for instructions if you are taking any of the following medications:
- Over-the-counter medication
- Diabetes medication (insulin, Glucophage, or others)
- Heart medication
- Do not eat or drink anything after midnight the night before your test.
- Do not take any medication unless you have discussed this with your doctor on the morning of the test.
- A prescription slip from your doctor
- An insurance card and/or referral slip (if needed)
- A responsible adult to drive you home
- A list of your medications and allergies
What will happen before the test?
- You will sign a consent form for the test.
- You will be asked to change into a hospital gown.
- An intravenous (IV) line will be started in your arm.
- You will be asked to remove your glasses, contact lenses, dentures, and jewelry.
- The back of your throat will be numbed with a spray.
Let your doctor or nurse know if you are allergic to iodine or shellfish, because you will receive an injection of a dye that could cause an allergic reaction.
What will happen during the test?
First you will be positioned on your abdomen. Your nurse or doctor will inject medication into a vein in your arm to help you relax. Once you are relaxed, your doctor will place a guard over your teeth and gums to help protect them from the endoscope. Then he or she will pass the endoscope through your mouth and into your stomach and duodenum to take x-ray pictures of your bile ducts.
There is an opening (papilla) in the duodenum where the bile and pancreatic ducts empty. A small catheter (soft tube) will be inserted into this opening to inject a contrast dye. This dye shows up on x-ray images and helps the doctor see the ducts, and any problems, more clearly.
You may be asked to change position during this test. A nurse will help you do this. Your blood pressure, pulse, breathing, and blood oxygen levels will be monitored during the test.
Once your doctor has identified the problem, he or she may need to perform one of the following procedures:
- Sphincterotomy (sfingk-te-ROT-ohme). If x-rays show a gallstone or other blockage, your doctor may choose to treat it by enlarging the opening of your bile duct. He or she will make a small cut in the bile duct with an electrically heated wire. You will not feel this cut. Gallstones will be crushed through use of a special instrument. The tiny pieces will either be removed using a balloon, or they will be left to pass into your intestines, where they will be eliminated naturally.
- Stenting. If your doctor notices a narrowed duct, he or she may choose to place
a stent in the duct. A stent is a tiny plastic tube that can help keep a duct open. Stenting can
relieve jaundice (a condition caused by an interruption in bile processing) by allowing bile to drain into the intestines. Stents are sometimes placed in the pancreatic duct when it is blocked. Stents can be pushed through the endoscope and placed
into a narrowed area of the bile duct.
- Nasobiliary (NAY-zoh-BILL-ee-air-ee) draining. Sometimes, a long, thin plastic tube, called a nasobiliary tube, is left in the bile duct and brought out through the nose. This allows bile to drain so more x-rays can be taken. The tube may be kept in for a few days. It may be slightly uncomfortable at first, but it will not interfere with eating or drinking. The ERCP and other procedures should take between 30 minutes and two hours total.
What will happen after the test?
You will remain in the recovery area until the effects of the medication have worn off. Please talk to your doctor about the possibility of staying overnight. You may experience the following:
- You may have a mild sore throat or numbness in your throat.
- You may feel full or bloated. This feeling is due to air that was put into your stomach during the test. This feeling usually passes quickly, although it may last several hours.
- You may feel drowsy. Your nurse may swab the back of your throat with a cotton swab to test your “gag reflex.” Once this reflex has returned and you are swallowing normally, you may eat or drink whatever you would like.
What should I report to my doctor?
Call your doctor immediately if you have the following symptoms:
- Temperature of 101°F or above
- Blood in your stool
- Black, tar-like stools
- Pain in your abdomen, chest, or back
- Nausea or vomiting
- Weakness, dizziness, or fainting
When/How do I get my test results?
Your doctor will discuss the results of your test with you. Please talk with your doctor and/or testing center about how to get your test results.
If you have further questions, call:
What I need to do:
- Schedule an appointment at __________________________(place) on _________(date).
- Report to __________________________________________________ at _________(time).
- Receive specific instructions: _________________________________________________
- Bring your prescription, insurance information, and/or a referral slip.
- Bring a list of medication and allergies.
- Arrange for transportation with a responsible adult driver.
- Tell your nurse or technologist if you are pregnant and/or breastfeeding.
Reviewed April 2011