Endoscopic Retrograde Cholangiopancreatography (E.R.C.P.)
Why do I need an E.R.C.P.?
After careful medical assessment, your doctor will decide whether an E.R.C.P. (Endoscopic Retrograde Cholangiopancreatography) is necessary for further evaluation and treatment of your condition. E.R.C.P. is a highly sophisticated technique requiring special endoscopic training, and can be accomplished successfully in a high percentage of patients. This leaflet has been prepared to help you understand this procedure.
What is E.R.C.P?
A long flexible tube, slightly thinner than a pen is passed through the mouth and back of the throat, into the duodenum (the first portion of the small intestine). The opening from the bile duct and pancreatic duct into the duodenum is identified. A small plastic tube (cannula) is then passed through the endoscope into this opening and directed into the bile duct and/or pancreatic duct. Contrast material (dye) is then injected and x-rays are taken to study these ducts.
What preparation is required?
For the best possible examination, the stomach must be completely empty, so you should have nothing to eat or drink, including water, from 11pm the evening before the examination or for at least 8 hours before its performance. Your doctor will be more specific about the time to begin fasting, depending on the time of day your E.R.C.P. is scheduled. Be sure to let your doctor know if you are allergic to any drugs or have had an allergic reaction to iodine dyes. A companion must accompany you to the examination because you will be given an anaesthetic sedation to help you relax. It will make you drowsy, so you will need someone to take you home. Legally, you are considered to be under the influence of mind-altering drugs and therefore you will not be allowed to drive after the procedure. Even though you may not feel tired, your judgment and reflexes will have been affected by the sedation. Most patients are kept in hospital overnight for observation. It is important to let your doctor know if you have had any barium x-rays within the past week, as barium may interfere with this test. Please bring your x-rays with you, as they may be important.
What to expect during the procedure?
You will be given an anaesthetic sedation through a vein to make you relaxed and sleepy, and your throat may be sprayed with local anaesthetic. While you are lying in a comfortable position on an x-ray table, the E.R.C.P. endoscope will be inserted through the mouth and into the duodenum. During the procedure, while x-rays are being taken, you may be asked to change your position. The tube will not interfere with your breathing, and any gagging is usually prevented by the sedation. During the procedure, you may feel bloated due to the air used to inflate the intestine. As x-ray contrast material is injected into the ducts, you may also feel some discomfort.
What happens after E.R.C.P?
You will be observed in the endoscopic area until most of the effects of the sedation have worn off. You may feel bloated and might have a soft bowel movement because of the air and contrast material that were introduced during the examination. You will be able to resume your normal diet after the procedure unless you are instructed otherwise.
Are there any complications from E.R.C.P?
E.R.C.P. is safe, and is associated with very low risk when performed by physicians who have been specially trained and are experienced in this highly specialised procedure. Complications can occur but are uncommon. One possible complication is pancreatitis due to irritation of the pancreatic ducts by the x-ray contrast material. Another possible complication is infection. Localised irritation of the vein where your sedation is injected may also occur. A tender lump develops which may remain for several weeks to several months but does eventually go away. Other less common risks include perforation (tear) of the bowel, drug reactions, and complications from unrelated diseases such as heart attack or stroke. Death is extremely rare, but still remains a remote possibility.
What are the reasons for performing E.R.C.P?
E.R.C.P. is a valuable tool for the diagnosis of many diseases of the pancreas, bile ducts, liver and gallbladder. An abnormality suspected by clinical history, blood tests or x-ray can be confirmed and studied in detail. The cause of an obstruction to the flow of bile may be found in a patient who is jaundiced. The diagnosis may be made in a patient who is not jaundiced when symptoms suggest disease of the bile ducts or gallbladder. If a blocked duct is found, surgery may be required without delay. In patients with suspected or known pancreatic disease, E.R.C.P. will help to determine the need for surgery and the best type of surgical procedure to be performed. E.R.C.P. is a safe and extremely worthwhile procedure which is well tolerated. The decision to perform this procedure is based upon assessment of your particular problem. If you have any questions about your need for E.R.C.P, do not hesitate to call our rooms for further advice or information.