Endoscopic Retrograde Cholangiopancreatography
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What is the procedure for ERCP?


What Is Endoscopic Retrograde Cholangiopancreatography (ERCP)?

Endoscopic Retrograde Cholangiopancreatography definition – is an endoscopic procedure used to treat a specific finding within either the pancreatic duct or bile duct (biliary tree). ERCP is an advanced endoscopy therapeutic procedure more commonly performed in adult patients. It allows the physician to examine pancreatic and bile ducts using a bendable, lighted tube called an endoscope. Paediatric disease processes in need of an ERCP are similar but may be different from the indications in adult patients.

How do you need to prepare before the ERCP test?

Endoscopic Retrograde Cholangiopancreatography procedure is minimally invasive. Before going through the procedure, you need to understand the indications and all the possible risks which may occur in rare cases. Therefore, always ensure that you consult with your doctor before your procedure – to guide you properly about the important aspects of the procedure.  Similar to gastroscopy, an ERCP procedure generally requires 6-hour fasting to ensure an empty stomach before the procedure. You should continue your usual medication before the procedure. 

Always inform your doctor if you are taking any blood-thinning agents or any diabetic medicines. Always follow the instructions given during your pre-procedure counselling. ERCP is usually done under sedation in a prone position and it takes about an hour to two. To ensure comfort, you will receive a sedated agent intravenously in addition to the local anaesthetic throat spray.

What settings is Endoscopic Retrograde Cholangiopancreatography performed?

Endoscopic Retrograde Cholangiopancreatography is generally performed in two settings and usually depends on the patient. Some patients may be brought in with prior infections in the biliary tree, cholangitis, or a patient who might have an impacted stone that could’ve led to pancreatitis. These usually comprise of the sick patients who are already admitted in a hospital. In simpler words, an ERP is a procedure with a camera but is used in conjunction with an X-Ray machine. There is minimal dose of radiation given to the patients and the amount of radiation provided is recorded.

Then there are the outpatients that come for an elective procedure. In general, the procedure is performed in the same way but two different settings. Patients are advised to undergo a 6 hour fast to ensure an empty stomach during the procedure. At first, the patients are prescribed to see an anaesthesiologist so that they are sedated and don’t feel any pain during the procedure. 

What is the equipment used for ERCP?

For an Endoscopic Retrograde Cholangiopancreatography (ERCP), doctors use a long scope that has a side-viewing camera which is introduced through the mouth. During the procedure, the doctors have to push in the air to localise the area called the major papilla. The devices such as different types of cannulas, central tones, balloons, baskets, and many more, help open up the insides and allow the doctor to take a look at what is going on with the help of radiology and injecting contrast. 

This allows the doctors to see everything behind the bowels – location of the ducts. There are no Incisions made through the skin. The use of the above-mentioned devices supported by radiology allows the doctors examine, recognise the stone, open the ducts, and remove the stones.

What is the procedure for ERCP?

  1. A duodenoscope is inserted through the mouth and into the duodenum.
  2. A guidewire is inserted into a branch of the pancreatic duct.
  3. A second wire and cannula are inserted.
  4. Contrast is injected to partially highlight the pancreatic duct.
  5. The first wire is then removed and advanced up into the common bile duct.
  6. The guidewire is then passed up the liver stone.
  7. A balloon catheter is advanced over the guidewire.
  8. A temporary flexible stent is then placed through the previous ductal narrowing to allow the duct to heal.
  9. The stone is pulled out into the duodenum.
  10. The balloon is inflated above the stone, which is then removed from the bile duct pulling the stone into the intestines, where it will pass out of the body within the stool.
  11. After a few weeks in a place, the stent is removed.

Depending on the findings – treatments of stone disease and abnormal narrowing can be provided using specialised instruments. Tissue samples may be taken and stents may be inserted into the respective ducts to allow proper drainage.

What Are The Risks Of ERCP?

The procedure is dependent on multiple factors. A patient’s anatomy is one of the risks associated with ERCP. Some other risks include prior surgeries, infections, or a majorly difficult papilla. All of these may increase possible complications. The main complications from ERCP are pancreatitis, bleeding, perforating, and very rare infections. Major complication is pancreatitis and has often been reported in a handful of procedures. To avoid pancreatitis, doctors tend to hydrate the patients with an IV before they get into the procedure.

How Should Patients Prepare For An ERCP?

The first thing to do before getting an ERCP is getting to know what ERCP means and how it is done. It is equally important to determine what medications the patient is currently on. If a patient is taking blood thinner medications, they need to stop those medications as they can induce bleeding while removing the stone.

Patients need to have a good health history and should be in constant communication with their doctors and particularly the cardiologist when they’re taking blood thinner medications. The patients, in consultation with their doctors and cardiologist, should always take a joint decision in terms of the procedure as well as the medications.


Do you have to stay in the hospital after the ERCP procedure?

After the procedure, do expect to be admitted for an overnight observation of any procedure-related complications. You may be discharged the following day with instructions on self-care provided to you. Please return for your outpatient review if a follow-up visit is deemed necessary by your doctor.

What is the cost of an Endoscopic Retrograde Cholangiopancreatography procedure?

The cost depends on various factors like in-patient or out-patient status, first time patients or patients following a previous similar procedure, hospital facilities, location, and complication of your condition. The cost can range between $2000-$5000.

How much time does ERCP take?

ERCP is a major procedure – it involves looking inside a patient’s gallbladder or bile ducts and removal of gallstones if any are found. The procedure can take anything from 30 mins to 90 mins – depends on presence of gallstones, no. of stones, and patient’s comfort level.

Does an ERCP procedure hurt?

Although ERCP is performed under sedation, a patient might feel discomfort after the procedure is commenced. Large volume of air is pumped during the procedure, leading to bowel distention and discomfort. Also, elevated levels of gastric juices are reported – amylase and lipase, after the ERCP procedure. The above reasons are why patients are monitored in the hospital post-procedure.

How long does recovery take and how soon can you eat?

Complete recovery usually takes 14 days, you will be advised not to drive, swim, get into hot tubs and avoid excess physical activity by your healthcare provider. Eating immediately after ERCP procedure is not advised – your physician will recommend you for liquid diets after 24 hours.

The information provided in this blog is for educational purposes only and should not be considered as medical advice. It is not intended to replace professional medical consultation, diagnosis, or treatment. Always consult with a qualified healthcare provider before making any decisions regarding your health. Read more